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Malaysian researchers create walnut 'Viagra'.

: woremore; November 1st, 2011

See also: viagra online pharmacy | cialis online pharmacy |

Kuala Lumpur: Malaysian researchers claim they have created a nutty alternative to Viagra based on walnuts in a pill more healthy than its pharmaceutical counterpart, according to a report on Sunday.

Kim Kah Hwi, who headed the team of researchers from the University of Malaya, said he was inspired to look into walnuts after reading about their use in history, the Star daily reported.

"I read articles about the Romans and French having eaten walnuts for this purpose. I thought if it had been documented that long ago, then there surely has to be something there," he told the newspaper.

It took Kim and his research team two years to develop "N-Hanz", tablets which contain walnut extract and have shown positive results on 40 volunteers against erectile dysfunction.

"It takes about an hour for the effects to set in and it will last for about four hours," said Kim.

"Furthermore, because it is not a drug, it is safe for those with hypertension or diabetes, or (those) who have recently had heart bypasses," he said.

Major New Study Published in PLoS Medicine

: woremore; October 29th, 2011

See also: online pharmacy |

I have been waiting for some time to post this information and am delighted finally to be able to do it--see the article just published on line in PLoS Medicine:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000352#top

This article by Spurling et al. represents the brain trust of Healthy Skepticism in Australia, with input from Canada's Joel Lexchin--in short, the people around the world who have most closely tracked the evidence for drug industry influence over medical practice.

The problem they set out to address is one I explained some time back:
http://brodyhooked.blogspot.com/2010/02/what-would-it-take-to-prove-harm-from.html

The ideal evidence that we pharmascolds seek--that accepting gifts and information from the drug industry leads to worse prescribing by docs--will never be available because the necessary randomized, controlled trial that would establish causation will never be done. Pharmapologists have seized upon this situation to assert the opposite state of affairs, that there's simply no evidence at all of harm arising from industry marketing, therefore we pharmascolds base our position solely on ideology and not on evidence. As I have also noted, we pharmascolds make things worse by repeatedly, in knee-jerk fashion, citing the systematic review by Wazana in JAMA, 2000. This review is now nearly worthless for two reasons. First, it's woefully out of date; second, if you read it carefully, it "proves" almost nothing--perhaps that more contact with drug reps makes docs who serve on formulary committees more likely to recommended company drugs.

In short, what we have needed for a long time is an up-to-date, very careful review of the existing literature that addresses the actual evidence base for the argument against drug company influence. Finally we have that review.

Spurling et al. surveyed the literature and carefully pared down their sample to 58 published studies. Almost all of these were observational studies. They were able to do a meta-analysis of one set of studies, but mostly had to do a narrative review because of the heterogeneity of the research methods. In short they were quite careful not to claim more than they could back up.

I will copy their abstract as to their main findings:

"Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. "

Their conclusion:

"With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies."

My own way of stating the results: There are a lot of reasonably well-done studies of the subject, given the inherent limitation that only observational studies and not randomized trials are usually feasible. These studies show that when an influence can be detected, drug industry marketing exerts a negative influence on the quality of physicians' prescribing (including unnecessarily higher costs as a negative feature). It is vanishingly rare to find a study that shows an improvement in quality. There is a body of evidence, and it overwhelmingly tilts in the direction of supporting recommendations that physicians try to minimize influence from and contact with the industry.

Wazana A (2000) Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 283: 373–380.

Whoopee! Let's go whole hog on Iraq foes until they squeal -- big surge advocates say

: woremore; October 29th, 2011

Bemusings is ecstatic! If famous Military Madman Frederick W. Kagan and his small but resolute band of Merry Neocons have their way, the United States will get back to the original 9/11-inspired 'masterplan' for the liberation of Iraqi freedom fighters and the quick and brutal demise of the terrorist forces.

In other words, Victory on the hoof! Surrender is no substitute for victory! God bless America and help us boil the terrorists alive! Free enterprise for Iraq is still a dream worth dying for!

President Bush is reconsidering his Iraq options in the face of doubt and questioning in the media of his manly pursuit of freedom, Kagan says in his latest Washington Post op-ed, co-authored by one of this nation's great military heroes, retired Gen. Jack Keane.

Even the headline stirs the soul of real patriots: "The Right Type of 'Surge' -- Any Troop Increase Must Be Large and Lasting."

Kagan's call for a large and lasting surge could make the difference for Bush by providing not only size but staying power as well.

He proposes at least 30,000 new combat troops to 'clear and hold' Baghdad to provide real security to the city residents.

The boldness of Kagan's clarion call could provide the needed dose of online pharmacy needed to win in Iraq instead of the old-fashioned, impotent, weanie-shrinking Viagra where you gotta evacuate the troops as soon as possible or risk threatening your marriage.

As an example, if you had a plan that guaranteed 36 hours where you could 'pick your time to call the shots', that would be a terrific improvement over one or two lousy hours to pack up and leave the house. While the moderate consensus compromise position of Levitra, sounds good, why not go with the best and go all the way to victory?

The facts back up Kagan's basic points about size and staying power. According to WebMD.com,

Quote What Are the Differences Between Cialis, Levitra, and Viagra?

Cialis, Levitra, and Viagra work by a similar mechanism to cause erections. There are subtle differences in how long the drug works and how quickly it works. Levitra works a little longer than Viagra. They both take effect in about 30 minutes. With Levitra, the effects last for about 5 hours. With Viagra, the effects last approximately 4 hours.
</strong>
Cialis works a bit faster (within about 15 minutes), and the effects last much longer -- up to 36 hours in some cases. Endquote

Let's let Kagan (and of course Gen. Keane) provide some voyeuristic [Definition Number 2, please! = persistent observer of misery or scandal: Early 20th century. French, "somebody who sees" -- voir "see" from Latin videre] descriptions of his plan:

Quote We need to cut through the confusion. Bringing security to Baghdad -- the essential precondition for political compromise, national reconciliation and economic development -- is possible only with a surge of at least 30,000 combat troops lasting 18 months or so. Any other option is likely to fail.

The key to the success is to change the military mission -- instead of preparing for transition to Iraqi control, that mission should be to bring security to the Iraqi population. Surges aimed at accelerating the training of Iraqi forces will fail, because rising sectarian violence will destroy Iraq before the new forces can bring it under control . . .

Of all the "surge" options out there, short ones are the most dangerous. Increasing troop levels in Baghdad for three or six months would virtually ensure defeat. It takes that long for newly arrived soldiers to begin to understand the areas where they operate. Short surges would redeploy them just as they began to be effective . . . In addition, a short surge would play into the enemy's hands . . .

The size of the surge matters as much as the length. Baghdad is a large city. Any sound military plan will break the problem of bringing security to the Iraqi capital into manageable parts. But there remains a minimum level of force necessary to make adequate progress in a reasonable time.

Clearing and holding the Sunni and mixed Sunni-Shiite neighborhoods in the center of Baghdad, which are the keys to getting the overall levels of violence down, will require around nine American combat brigades (27 battalions, in partnership with Iraqi forces, divided among some 23 districts). Since there are about five brigades in Baghdad now, achieving this level would require a surge of at least four additional combat brigades -- some 20,000 combat troops.

Moreover, it would be foolhardy to send precisely as many troops as we think we need. Sound planning requires a reserve of at least one brigade (5,000 soldiers) to respond to unexpected developments. The insurgents have bases beyond Baghdad, especially in Anbar province. Securing Baghdad requires addressing these bases -- a task that would necessitate at least two more Marine regiments (around 7,000 Marines). It is difficult to imagine a responsible plan for getting the violence in and around Baghdad under control that could succeed with fewer than 30,000 combat troops beyond the forces already in Iraq.

It is tempting to imagine that greater use of Iraqi forces could reduce the number of U.S. troops needed for this operation. The temptation must be resisted . . . We cannot allow that mission to fail simply because some Iraqi units don't show up, aren't at full strength or are less reliable than we had hoped.

The United States faces a dire situation in Iraq because of a history of half-measures. We have always sent "just enough" force to succeed if everything went according to plan. So far nothing has, and there's no reason to believe that it will. Sound military planning doesn't work this way. The only "surge" option that makes sense is both long and large. Endquote

Well, as they used to say in the old days, there you have it. A plan for victory that could only be bettered if Errol Flynn, Alan Hale and Ronald Reagan were playing the leads in such a desperate journey to save freedom from the bloody hands of the terrorists.

And there you have your ultimate American citizen multiple choice: Viagra, Levitra, or Cialis? Name your weapon's caliber, .22, .32, or the big Magnum .44? Big, long-lasting surge or premature ejaculation? Victory or shameful cut-and-run defeat?

A final warning. The Kagan-Keane plan requires only one plan, theirs, to be put into action. Trying to switch mid-stream won't work, as this caution from WebMD suggests:

Quote If One of These Drugs Isn't Effective for Erectile Dysfunction, Can I Try Another?

Because these drugs work the same way, it's unlikely that you'll have success with one if you've failed to achieve an adequate erection with another. Endquote

Viagra advertising

: woremore; May 24th, 2011