Category Archives: education

WEAKLY HUMERUS NEWS 05-10-08

There will not be an issue of Humerus News next week.

TOP QUOTES OF THE WEEK

According to a new survey by the Pew Social and Demographic Trends Project, more Americans would rather have more free time than money. If the economy continues slowing, their wish will be granted pretty soon. (Pedro Bartes)

The slowing U.S. economy has led to the most significant drop in illegal aliens coming in from Mexico since 9/11. Who knew that President Bush’s immigration policy revolved around starting a depression? (Jim Barach)

I was thinking about this, and I’m no political genius. I’m no pundit, but it occurred to me that Hillary Clinton has one thing in common with President Bush. Neither of them has an exit strategy. (David Letterman)

Jenna Bush gets married on Saturday. It’ll be a very small wedding. The president has only invited his supporters. (Alan Ray)

The U.S. government plans to help Iraq build a mega shopping complex in downtown Baghdad. Security will be a factor. It’ll bring new meaning to the phrase “shop ’til you drop.” (Alan Ray)

A new poll suggests that George W. Bush is the most unpopular president in modern American history, to what Bush said: “Number 1 baby, number 1!!!” (Pedro Bartes)

President Bush says that the $300 rebate checks from the government will finally be mailed out on Monday. Then, Americans can decide whether to save the $300 or use it to buy half a tank of gas. (Conan O’Brien)

Hillary needed to win decisively in both states tonight, she didn’t do that, which means her chances to win the nomination are very slim. But will she quit? Oh, not a chance. She will stay in the race for as long as it takes to elect John McCain president. (Jimmy Kimmel)

They’ve discovered a way to make a human being absolutely invisible. All you have to do is run for president as a Republican. (Patrick Gorse)

President Bush held a big Cinco de Mayo dinner celebration last night at the White House. He praised the people of Mexico who come here to do the jobs the Americans don’t want to do, as opposed to the people of India, who are doing the jobs Americans did want to do, but can’t, of course, anymore. (Jay Leno)

Indiana poll workers turned away a dozen nuns trying to vote Tuesday when they didn’t have photo IDs. They all walked out in a huff. Al Gore saw the clip and said it was just more evidence of global warming to see penguins this close to the equator. (Argus Hamilton)

Drake University has become the third college in the nation to offer a course in wind law, joining the University of Texas and the University of Oregon. It’s a prerequisite course. In order to study environmental law, you first have to pass wind. (Bob Mills)

The Yankees yesterday placed Alex Rodriguez on the disabled list. It’s actually the first time since 2000 that the third baseman has been inactive. Well, other than the playoffs. (Janice Hough)

President Bush’s popularity is so low now, on his Facebook page, he only has imaginary friends. (Jay Leno)

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AN IMITATION OF FLATTERY

Someone is taking this blog rather seriously, and copy-pasting stuff in websites.
There is this article on Biointelligence and Morphological Freedom that seems to be lifted right out of the pages of this blog.
Huh.

UNIVERSAL WATER: FUTURE OR FANTASY?

As social scientists, economists, and environmentalists keep telling us, much of the world’s poor can be defined by their lack of adequate access to safe and potable water.
Says futurist Peter von Stackelberg, “By 2025, about 3.4 billion people will live in regions that are defined by the UN as water-scarce.”

Original article: here.

SOLUTIONS:

If we are indeed going to drown in drought, what solutions are available?

While much of the future of universal water depends on political and social activity, technological advances in three major areas will be critical for the hydrological future: desalination of seawater or brackish groundwater, purification of water containing chemical or biological contaminants, and conservation to cut demand.

*Flash Desalination: Using a source of high energy, sea water is heated till the vapor accumulates in a low-pressure chamber. Indian scientists have invented a low cost version of this which uses less energy.

*Water harvesting:

In Beijing, the National Stadium built for the 2008 Olympic Games is designed with a nano-filtration system and underground pools that can capture and process up to 100 tons of rainwater an hour. Seattle’s King Street Center, a 327,000-square-foot commercial building constructed in 1999, captures rainwater for use in the building’s sewage system and for landscaping needs, saving about 1.5 million gallons of water a year.

*Smart Water Application Technologies (SWAT):

This is one way to curb water usage. For instance, irrigation of residential landscapes typically applies 30-40% more water than needed. But a system that has been tested in California, Washington, and several other western states has linked sensors that monitor rainfall and soil moisture to a “smart” controller. Water consumption has decreased by an average of 26%, with some consumers cutting their usage by as much as 59%.

von Stackelberg stresses that there are three factors which will influence water availability in the future: low-cost power for desalination, nanowater (high-tech filtering), and green engineering, wherein zero wastewater from industrial facilities is achieved.

“A paradigm shift will be required if water shortages are to be avoided,” von Stackelberg says. Among these newer attitudes are the beliefs that human waste is a resource from which water can be harvested, and that storm water is a resource which needs to be captured and stored.

Though water usage is decried by most, I believe that it is impractical and perhaps unnecessary to do so. Surely, science will find a way out to make water widely available. After all, much of the planet is covered by oceans and seas. The problem, as I understand it, rests largely on how we can make sweet water from the sea.
Once again, the world will look to these solutions not from the laboratories of Cuban or Indian Governments, but the research centers of the First World, or private labs anywhere, including developing nations. After all, there is money to be made, Nobels to be won, and names to be immortalised if one can provide a solution to this global problem.
Nothing moves the world as much as love greed.

WEAKLY HUMERUS NEWS 02-23-08

TOP QUOTES OF THE WEEK

Over in Africa, President Bush is being welcomed as a hero in Tanzania. See, that’s because President Bush always said one day third world countries would have the same economy as the United States and thanks to his economic plan, now they do. (Jay Leno)

So John McCain has now embraced the Bush tax cuts and voted against an anti-torture bill. He didn’t need Mitt Romney’s recent endorsement – he’s become Mitt Romney. (Janice Hough)

Four strands of George Washington’s hair sold for 17-grand at a Kentucky auction. There were rumors that his teeth were up for bidding. But they turned out to be false. (Alan Ray)

The Hallmark meat packing plant that caused the biggest meat recall in U.S. history may shut down. But its defenders say Hallmark lived up to the slogan, “When you care enough to send the very wurst.” (Scott Witt)

This campaign is kind of fascinating, because the three major candidates have to be very careful when they criticize each other. Like, you can’t criticize Hillary. Ooh, that’s sexism. You can’t criticize Barack. Ooh, that’s racism. And you can’t go after McCain, because that’s elder abuse. (Jay Leno)

Paris Hilton made went to Harvard to pick up the Harvard Lampoon’s Woman of the Year trophy. This marks the first and only time the words “Paris Hilton went to Harvard” have ever been used. It was awkward when they tried to explain to Paris that the award was an example of irony, Paris said; “Like my maid totally does all of my ironing.” (Alex Kaseberg)

An 18 year old Utah woman won the title of best grocery bagger. She immediately got all kinds of proposals from guys who heard she was great in the sack. (Jim Barach)

University of Washington scientists have invented a tiny camera that you swallow so it can take interior pictures — such as inside a bile duct or fallopian tube. They’re not sure it’ll work in the intestines, however. That would be too much of a crap shoot. (Scott Witt)

After the latest victories, Obama told his followers at a rally that Hillary can’t catch him, quoting the famous words of a former president: Bill Clinton. (Pedro Bartes)

Carl Rove told an interviewer that “Years from now, people will thank God that Bush invaded Iraq.” Unfortunately, they’ll be kneeling on prayer rugs, adjusting their dynamite vests, and facing Mecca (Bob Mills)

Thousands of bats are reportedly dying from a mysterious illness in New York. Authorities say they have never seen so many listless bats in New York outside of Shea Stadium. (Jim Barach)

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WEAKLY HUMERUS NEWS 02-02-08

TOP QUOTES OF THE WEEK

“60 Minutes” says Saddam Hussein faked having WMD to prevent an invasion from Iran. Well, he sure showed them. (Jim Barach)

Fox says they will not carry political ads during the Super Bowl telecast. The network says political ads should stay where they belong. Disguised as news stories on the Fox News Channel. (Jim Barach)

Exit polls showed that Bill’s campaigning actually hurt Hillary. I just hope it doesn’t cause any tension in their marriage. (Jay Leno)

President Bush has announced his new economic plan this week. It’s called “The Check Is In The Mail.” (Jay Leno)

There are rumors several writers might have crossed the picket line and started working again. The union suspects that only professional fiction writers could’ve written Bush’s last state of the union address. (Pedro Bartes)

Jessica Simpson has been linked with Arizona Cardinal QB Matt Leineart and Dallas Cowboy QB Tony Romo. In fact, Jessica has nailed more quarterbacks than the entire Oakland Raiders defensive line.

It looks like the Democratic field has really narrowed down. It’s going to be a black man or a white woman. A black man or a white woman. You know, this is the same decision Michael Jackson has to make every morning of his life. (Jay Leno)

President Bush gave his big State of Delusion address. In our last year’s State of the Union speech, President Bush said, “The economy is on the move.” This year he said, “Where’d it go?” (Jay Leno)

Mitt Romney … is a man who wants to be president. He is telling the Republican base, “I am Mitt Romney, Mormon android and I will say whatever you program me to say. I will run on a platform of stopping illegal immigrants from having sex with Bill Clinton until the surge has succeeded.” (Bill Maher)

The Herbal Nutrition Center in Los Angeles unveiled the world’s first marijuana vending machine Tuesday, which dispenses pot in an envelope after scanning the customer’s fingerprints and ID card. It’s controversial. This clearly discriminates against illegal immigrants in Los Angeles public schools. (Argus Hamilton)

Today is the 171st birthday of the flush toilet. Or, as Senator Larry Craig calls it, ‘the love seat’ (David Letterman)

Brijit.com is a new website that will condense magazine articles into a single paragraph for those who don’t have the time to read them in full. It was the idea of a guy who used to work at the White House removing the big words from Bush’s intelligence reports. (Bob Mills)

Have you heard this story? They’re trying to pass a bill now that allows politicians to insist that they be addressed by gender- neutral titles. Is that really necessary? I mean, don’t we already have gender neutral titles for politicians? ‘Crook,’ ‘liar,’ ‘adulterer,’ ‘pinhead,’ ‘moron,’ these are all gender-neutral. (Jay Leno)

Rudy Giuliani withdrew from the GOP presidential race Wednesday and no one can explain his lack of Republican support. It couldn’t be his Catholicism. With a trophy wife, gay friends, a pro-choice stance and warlike nature, he’s an Episcopalian in all but name. (Argus Hamilton)

Congressman Steve Wexler collected two hundred thousand signatures Friday calling for impeachment hearings. It’s too late. We engaged in pre-emptive war, torture, kidnapping and illegal wiretapping, and history will show the only one who went to jail was Kiefer Sutherland. (Argus Hamilton)

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SENT HENCE TO DEATH BY DOCTORS!

In this post, I present a fascinating discussion by some experts on the issues surrounding physicians being involved in judicial execution. This is a topic on which I have been thinking of posting for a while, but I will not offer my views on this now. Just read the transcripts of the interview, which I have taken from the New England Journal of Medicine. If you don’t have the ten minutes needed to read this, I suggest you come back when you do.
A video of the same may be seen here.

THE PROTOCOL

Dr. David Waisel: The three-drug protocol is based on what was considered a normal induction of anesthesia when it was developed. [The first drug is] thiopental, also known as sodium thiopental or pentothal, which is a barbiturate, which is designed to put you to sleep, create amnesia and anesthesia. Second comes pancuronium bromide, which is designed to paralyze the muscles. And the third drug, which is not a drug used in anesthesia, is potassium chloride, which is designed to rapidly stop the heart. The doses used are massive compared to the doses that would be used in a normal anesthetic induction.

Dr. Atul Gawande: You raised, Dr. Truog, [the question of] whether these are the right drugs.

Dr. Robert Truog: We’ve taken a pretty strong stand that paralytic agents have no role in end-of-life care. The concern is that they can mask the behavioral signs that we look to, as to whether or not a patient is comfortable. And we are deeply committed to making sure that patients are comfortable and as free of pain and suffering as possible during the dying process. And since we have medications that do relieve pain, that do sedate perfectly adequately, there’s no need to be introducing paralytic agents into end-of-life care. . . . It’s completely inappropriate to treat those signs and symptoms with a paralytic agent. I think that’s just as true in the execution chamber as in the hospital.

Professor Deborah Denno: According to the state, pancuronium bromide is used in order to enhance the dignity of the inmate who’s dying, because without pancuronium, there might be some jerking or involuntary movements that would disturb some of the witnesses. That I find problematic, and Justice Stevens certainly did.

Dr. Truog: From the point of view of the inmate, the argument seems bizarre. Imagine saying to the inmate, “You have a choice. You can either be assured of a pain-free death, and you may have some twitching and grimacing, or we can expose you to the risk of an excruciating death, but we’ll make sure that you don’t twitch or grimace.” I can’t imagine that an inmate would actually consider that to be a real choice.

ALTERNATIVE APPROACHES

Dr. Truog: The number one alternative that’s been proposed has been a very large dose of a barbiturate. A number of experts have said that 2 or 3 or 5 g of pentothal is absolutely going to be lethal. The fact is that, at least in this country, none of us have any experience with this. And if you look at a country where they do have some experience with it, their findings are pretty concerning.

If we go to Holland, where euthanasia is legal, and look at a study from 2000 of 535 cases of euthanasia, in 69% of those cases, they used a paralytic agent. Now, what do they know that we haven’t figured out yet? I think what they know is that it’s actually very difficult to kill someone with just a big dose of a barbiturate. And, in fact, they report that in 6% of those cases, there were problems with completion. And in I think five of those, the person actually woke up, came back out of coma.

LETHAL INJECTION AND THE EIGHTH AMENDMENT

Dr. Gawande: Professor Denno, [you’ve written that] in turning to this three-drug protocol back in 1977, “The law turned to medicine to rescue the death penalty.” What did you mean by that?

Professor Denno: Lethal injection came about in 1977, a year after the United States Supreme Court decided that there would no longer be a moratorium on the death penalty. And there had been acknowledged problems with electrocution and lethal gas, because of the visual side effects of those methods.

By virtue of coming up with a method of execution that makes an inmate look serene, comfortable, and sleeping during the death process, the death penalty in this country was rescued. The presence of doctors, their involvement, and the association with medicalizing the procedure enhanced its Constitutional acceptability.

Dr. Gawande: What does it mean to be not cruel and not unusual punishment [in compliance with the Eighth Amendment]?

Professor Denno: The Eighth Amendment has never said, nor have the petitioners ever argued, that executions are to be pain-free. The question is whether or not that pain is unnecessary, whether there are alternatives.

Dr. Gawande: Chief Justice Roberts asked, “Do you agree that, if the protocol is properly followed, that there is no risk of pain?”

Dr. Waisel: Define “properly followed.” In other words, the protocols list that this should happen and that should happen. But does that mean if everything happens correctly, if there are no problems with insertion of intravenous catheters, if there’s no problem with mixing up the medications, there’s no problem with delivery of the medications? Then, yes, it would be pain-free.

RISK OF ERRORS

Dr. Truog: I think the issue here is that people go to school for a long time and do years of training in order to be able to do this well. And certainly, everything that I’ve read is that the training for the people that are doing it in lethal injection is nowhere near adequate.

Dr. Gawande: In Kentucky, they have responded to the request by physicians not to have physicians involved. And so it’s staffed entirely by phlebotomists and emergency medical technicians. So how likely is it that errors will occur? By one measure, there have been 40 botched executions out of a little over 900, which suggests a 4-to-5% rate of failure.

Dr. Waisel: We have no idea what the error rate is, because there is no oversight, there is no public reporting. And the information [I] hear worries me. For example, I believe the case was from Missouri, in which they pushed the three drugs, and the inmate didn’t go to sleep. And [they] realized the strap holding the arm was functioning as a tourniquet. So they loosened it up, all the drugs came in at once. Now in that case, I’m highly confident that the inmate experienced a great deal of pain from the potassium chloride. And so I think that your 4-to-5% number is dramatically underestimated.

Dr. Truog: Putting an IV in is not as easy as it may sound. And being certain that it continues to remain in the same place also requires quite a bit of experience, because these catheters can become dislodged, they can go into the tissue, and then they won’t work anymore. Furthermore, we know that many of these inmates, by virtue of their history of drug abuse or obesity or being muscular, can be very difficult to start IVs in.

In a hospital setting, we have a lot of different ways of approaching the situation when we can’t get an IV in. Most commonly, we’ll just put in a central venous line. But that requires a great deal of training. The mixing, the administration of the medications [are] routine in any operating room in this country, but far from routine if you haven’t done it before.

One of the mistakes that I know has occurred happened to me early in my training, when I injected the paralytic agent too quickly after the pentothal, and they precipitated in the tubing. The tubing turned into a piece of concrete. Suddenly, I had no IV. And thank goodness, I was surrounded by very experienced anesthesiologists who stepped in, within moments had another IV. But I know that that has happened in executions, and it could be a disaster.

Dr. Gawande: The petitioners [noted that for] the 3 g of thiopental, no one makes 3 g syringes, so you have to constitute it from small vials of 0.5 g of powder. And several times, whether it’s doctors or non-doctors involved, they’ve simply mixed it up wrong and ended up with much lower doses than they thought.

In Kentucky, the risk of IV infiltration is exacerbated, because they use several feet of tubing, and everybody leaves the room and sits behind a screen where you can’t see the IV sites or monitor how well things are flowing in. And finally, they didn’t have a plan to monitor the depth of anesthesia when you don’t have anybody standing there. And to the extent that there is someone there, they’re not used to being able to assess this.

PHYSICIAN INVOLVEMENT

Dr. Gawande: Now we come to this fundamental question of whether physicians should take charge, to make death less painful. Dr. Truog, what’s your take on [Dr. Waisel’s] question: if you were to be executed, wouldn’t you rather have a capable, specialized physician doing this job?

Dr. Truog: If I think of the kind of a hypothetical where you have an inmate who is about to be executed and knows that this execution may involve excruciating suffering, that inmate requests the involvement of a physician, because he knows that the physician can prevent that suffering from occurring, and if there is a physician who is willing to do that, and we know from surveys that many are, I honestly can’t think of any principle of medical ethics that would say that that is an unethical thing for the physician to do.

Professor Denno: If we’re going to be executing people, I would prefer to have a method of execution where medical expertise would not be necessary. If we’re going to, however, have a method that would be cruel and constitute suffering if we didn’t have doctor involvement, then if there are physicians in the country who are willing to be involved, I would like to think that they would not be chastised or lose their license or be punished by the medical profession for volunteering to take part in an execution, to relieve suffering.

Dr. Truog: There’s been a lot written about whether physicians should participate in torture. And of course physicians shouldn’t participate in torture. But fundamentally, it’s because torture is wrong. And this is [similar] to my views about physician involvement in capital punishment. While I think at one level we can justify it, I think it’s to miss the bigger picture. I really believe that capital punishment is ethically wrong.

Living in the bubble of the United States, it’s easy to lose sight of just how much of an outlier our country is. We stand among a small group of countries that still do capital punishment, [and] I really don’t think we want to be in their company.

REMEDIES

Dr. Gawande: When we come to this question of where can the remedy be found, the directions that seem to be posed are: We involve physicians more and let them treat the prisoner as a patient, or we come up with alternative protocols that don’t involve physicians at all.

Professor Denno: My recommendation has been that there be a panel of experts who would propose a viable method of execution.

Dr. Gawande: It makes me deeply concerned, though, imagining us sitting around a table at a conference, trying to figure out various ways of executing people, and then the prospect of what that becomes, that we figure out that physicians have to be continually actively involved, and we create a specialty of the execution physician.

It may not be possible for the court to say that doctors would be allowed to really treat inmates as patients — control protocol, make judgments about how to make the suffering less or more — and leave them free to have that professional role.

Professor Denno: They’ve been doing that for 30 years. There have been physicians involved in lethal injection since the very first execution in 1982 in this country. Because of secrecy, we’ll never know the full involvement of doctors. But we have many examples of doctors having been involved, who have made these kinds of discretionary judgments about drugs or chemicals and what should be done.

Dr. Gawande: If the court says “We need this to go to an expert panel, with physicians, lawyers, public citizens, to determine a new protocol for execution,” would you participate on that panel? And should other physicians participate on that panel?

Dr. Waisel: It should be wholly permissible for physicians to participate if they wish. I would have to think about it very carefully. A large part would depend on the intellectual freedom involved in the panel, the ability to write a dissenting opinion from what the panel comes up with, and moving away from certain constraints that are put around this that seem not to permit what I would consider to be successful ways of nonphysician involvement.

Dr. Truog: I would not participate on that panel, because I don’t think that capital punishment is ethical. I think other physicians should be free to participate on that panel. And while I wouldn’t want to prejudge how they might come out, I can’t imagine that they are going to be able to develop an evidence base for any other approach that is likely to be successful without the immediate presence of a physician. And then I think we have to grapple with the ethics of that.

NAZIS IN DELHI

Indians, I have long worried, have a strong tendency to be against individual freedom. In the past, many assaults on liberties have taken place, some even enshrined in the Constitution.
Today I learned that Delhi University, including its Student Union, has banned smoking within its campus. Students will not be allowed to smoke in colleges, and on roads or anywhere else. Anyone caught smoking will be considered to be breaking the law, and fined. I suspect the laws also have imprisonment as one of the consequences for repeat offenders, but am not sure about that.

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I was taken aback at the virulence on the faces of some of the students campaigning for the ban. It seemed that all of their life’s problems would be over once smoking got banned. There were hardly a couple of feeble voices crying out for individual liberty and freedom.

Of course, I have discussed the issue of non-smokers’ rights in the past, maintaining that only the owner of a private property can declare his area off-limits for smoking. Otherwise, in public places, there have to be designated areas for smokers.

In this case, students are going to learn early in life the importance of cheating, of concealing truth, and bribing as a way of ensuring their self-interest. The police will benefit financially, of course, as will the media, with new stories to cover.

I can only wail at yet another bastion of individual freedom falling to the continuous onslaught of the control freaks, the Nazis of Correctness. Smokers are the new Jews.

The use of force to implement what is construed as the public good characterises every stormtrooper of righteous intent.

(pic credit: http://www.nyu.edu/socialwork/ip/news/archives/2007)

GETTING TO THE HEART OF ENHANCED CLAIMS

The recent controversy about the ENHANCE study is an important illustration of a serious and long-standing problem with the medical profession, and its allied siblings.

What is the ENHANCE study all about? Surely not a penis-enlargement issue, my readers may be forgiven for wondering even fleetingly. Well, it is a study on two treatment modalities for patients with high lipid (cholesterol, for example) levels. But, first, the basics.

You may have high lipid levels because of genetic reasons, or because you eat, drink, or smoke too much. Many of us are obese, too. Traditionally, if you have high cholesterol, apart from the usually discarded ‘lose weight-do exercise’ kind of advice to the patient, your doctor would give you drugs. These lipid-lowering drugs are called, broadly, statins. One of the most common ones today is Lipitor (atorvastatin).

Why is it important to lower cholesterol? Because high cholesterol can lead to fatty plaques being deposited in the coronary arteries (atherosclerosis), leading to a heart attack.

Statins are prescribed to millions of patients around the world, including those with heart disease, hypertension and diabetes (conditions commonly associated with high lipid levels). All statins act by blocking a liver enzyme that normally results in the formation of cholesterol.

The problems with statins are mostly with their cost and side effects. In addition, in a number of patients, they don’t work well enough. Increasing the dose may increase the side effects. So, what can your doctor do in this kind of scenario?

Enter Ezetimibe. This drug reduces the absorption of cholesterol from the intestines, which bear the brunt of all the cholesterol-rich good things in life that the mouth (along with the mind it carries) chases relentlessly.

With me so far?

So, you have statins that reduce cholesterol, and you have ezetimibe, that also does the same in a different way. Why not combine the two? Will surely work better, and reduce the fatty deposits in your coronary arteries, logically. Merck did that in collaboration with Schering-Plough, with Zetia (ezemitibe) and Vytorin (a $5 billion product).
A 30-day course of Vytorin costs around $100, while Zetia costs $93, compared to $32 for a course of generic simvastatin.

That is what the ENHANCE trial was supposed to prove. Unfortunately, it did not show any such benefit.

However, some experts are discounting the trial, saying it is not a fair representation of the truth, that it is botched, and that they would wait for further trials before changing their prescriptions away from Zetia. Around 60% of doctors, however, are likely to stop prescribing the drug. Obviously, it would be a catastrophe for the company, reeling as it still is from the Vioxx losses. Merck stocks have slid down after this trial has come to light.

The important issue that has come up again in this debate is captured in two quotes:

The main problem is that after six years on the market, there are no data for ezetimibe demonstrating any health outcome benefit. In the absence of any demonstrable effect beyond LDL lowering, nearly one million prescriptions per week are written for ezetimibe. Is this rational?

If the ENHANCE trial had shown regression of atherosclerosis or slowed progression, both the company and advocates of ezetimibe would be trumpeting the results as a landmark study. Now that the trial has failed, they describe ENHANCE as a small and unimportant imaging study. You can’t have it both ways!

THAT, ladies and gentlemen, captures a huge truth. Much of what we do as doctors stems from trials that prove one or the other. Products become available commercially, too, and we are tempted or habituated to use them, especially if treated well at cruises and exotic junkets. However, as clinicians, we would still want to do better for the patient, and refine our treatment methods as evidence improves. Therefore, it is vital that we know which data is proven, and which is putative, suggestive or alleged.

That, however, is a tall order!

(Sources: Heartwire and Medscape)

DEATH BY IMPOTENCE!

ED AND THE MALE WORLD

Erectile Dysfunction (ED), originally from the Latin Impotentia coeundi, is one of the major diseases of mankind, and can be loosely defined as an inability to achieve an erection for successful penetration.

In normal populations, the incidence of major Erectile Dysfunction (ED) is 5 to 20%. Even in the young, ED occurs in around 13%, according to a study on boys between 18 and 25 years. This is remarkable, because ED is known to be seen in older, not younger men, as a rule.

One of the most respected and cited studies on the epidemiology of erectile dysfunction is the Massachusetts Male Aging Study. The study showed that 52% of 1,290 men aged 40 to 70 years had some degree of dysfunction, and almost 10% had total absence of erectile function.

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A new article in The International Journal of Impotence Research has some interesting things to say, based on a large study on the sexual habits of more than four thousand men, both gay and straight.

Most men in the prime of their sexual lives (18 to 44 years) use no drugs for sex, while some do it for recreational use, and fewer because they need to use them medically.

The recreational use of ED drugs is increasing, and seems to have a negative effect. The study says that, on surveying the participants’ perceptions and self assessments after taking ED drugs, their confidence and performance suffered unless they took drugs again.

As lack of confidence in one’s ability to gain and hold erections has been identified as an important psychogenic risk factor for ED, the findings have important implications. Recreational users of ED medications may be vulnerable to becoming psychologically dependent on pharmacologically induced erection.

Therefore, the young kids out for a trip on Viagra are rooting for trouble!

WHO CARES ABOUT ED, A BORING MALE DISEASE?

ED is now more than an andrologist’s way of making bread. It is now a sentinel for a variety of diseases. What are they?

* ED may be the first symptom of coronary heart disease in a young man. In fact, ED is now considered a strong indicator of heart disease, with strong correlation as to severity. In other words, the more severe the heart disease, the greater the liability to be having ED. Men who have less than expected degree of erection, or have it only to lose it midway (lazy erections) are likely to have a cardiovascular cause of ED.

* ED may present in an undetected diabetic.

* It is seen in long-standing smokers, alcoholics (whiskey dick or brewers’ droop), and those with lipid disorders, prostatic diseases, etc.

* Evidence has linked hypertension to ED.

* Drugs used in the treatment of various diseases can also cause ED.

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IMPOTENCE IN INDIA

India has been called the country of unconsummated marriages because of the phenomenon of ‘honeymoon impotence’, when ED manifests on the first attempt. Impotence in India is mainly psychogenic, unlike the rest of the world, where three-fourths of cases are said to be due to organic, not psychological causes. Of course, once a man becomes impotent, he suffers enormous loss of confidence and self-image, leading to further performance anxiety. So the psychological overlay (no pun intended, for once) is also visible here.

HOW DOES ONE TREAT ED?

If you are a man facing ED, the sensible thing is not to hide it, but come out with it to a physician. Screening for hypertension, diabetes and heart disease will follow. Smoking should stop, as should excessive boozing.
Then what?
Based on what is wrong with the patient, the treatment is commenced.
Usually, drugs like Cialis (tadalafil) are the first line of treatment. Among the ED drugs, a lot has changed since Pfizer came out with Viagra. Leftist limpos: please note that Viagra was not invented by a Government pharma company.
Cialis (Tadalafil) is now a preferred drug for ED patients. It works for 36 hours, can be taken irrespective of food, and one does not need to time the drug intake with sex, thereby making for a better experience. In contrast, Viagra (sildenafil) works for only four hours and needs to be taken half an hour or so before sex.
In some cases, the doctor may advise the patient to inject a substance like papaverine or a prostaglandin (Alprostadil) into the penis just before sex. Rigidity is best achieved with injections.
In psychological cases (performance anxiety, depression, schizophrenia, etc.), counselling and appropriate treatment is advised.
Specific cases where the penis loses rigidity due to blood leaking from the veins respond well to vacuum suction devices.

SURGERY FOR IMPOTENCE?

In a small percentage of cases, where there is no response to any of the above, the andrologist might consider implants. These are devices that are implanted inside the penis (and partly in the scrotum). One device (essentially a semi-rigid rod of silicone with metal wires), called the AMS prosthesis, may lead to a permanent semi-erect state. In India, it costs around 60,000 rupees (around 1150 USD). A local version has been made by andrologist Rupin Shah and costs only Rs. 10,000 ($250). The better prostheses (e.g., the three-part inflatable AMS prosthesis) enable erection only during sex (on demand). A pump (implanted in the scrotum) needs to be activated to push in fluid inside an implant in the penis. The implant fills with water, and the penis becomes hard. This costs around Rs.220,000 ($5050).

One problem with the penile implant is that any infection is disastrous, leads to removal of the device, and permanent impotence. Hard luck!

It should also be remembered that any treatment of ED, like drugs or injections, may cause a persistent, painful, permanent state of erection, called priapism. This condition is an emergency.
Unless treated within four hours, it leads to permanent impotence.

To sum up, a man’s inability to achieve a satisfactory erection is not a laughing matter. It may be a sign of serious underlying disease which can eventually kill him.

Note: pictures are mine!

OF THE LOSE AND THE LAIM

I am loosing hope. Too in won days. There is no way the chronic lose spelling in Indian media is going to improve. I have long noticed that these are the pippuls who r entrusted by literate society to preserve the heritage and richness of the Inglees language.

But Google, et two?

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Look at The Statesman, a vulnerable venerble venerable mistress of the Queen’s language. This institute is one I speak off with regret. It has disdanefully letchured the world for more than a century on the rites and wrongs of issues, and in gramattically correct prose, too! Now all this is of, is it?

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Now, there is a schul of thot that doesnt much care for sp. n gramer. Shud I change ths paneful ‘politically incorrect but grammatically correct’ habbit of mine and swim with the currant?

Wud my reeders realy notice and bothr?
Do my enormous readers lissen to me or jes’ look at the dirty pitchers?

Ok, tata! Cu!!