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MY HEADACHES RUIN OUR SEX LIFE

April 30, 2007

Q SINCE being diagnosed with diabetes I have had problems with my sex life.

The doctor gave me a drug called Cialis to help but a few hours after taking it I get a bad headache and feel sick.

Is this normal as it is usually my wife who complains of a headache before sex, not me?

A CIALIS is a long-acting drug used to treat erectile dysfunction. It is quickly becoming more popular than Viagra as the effects don’t wear off after a few hours but can last for up to three days.

Like most of this kind of drug, Cialis can cause facial flushing and headache but the side effects take up to two hours to become apparent.

It is perfectly normal and nothing to worry about. I tell my patients to take a couple of paracetamol with their medication to avoid the headache.

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Q THERE is a horrible yellow substance building up between my teeth. I brush twice a day and floss but it still doesn’t get rid of it. A home bleaching kit just made it more obvious. I am too scared to go to a dentist.

A IT is probably tartar, a common build-up of hard plaque. It is usually due to a misalignment of your teeth.

Flossing and brushing regularly are good but you must visit the dentist for a scrape and polish to get rid of it. You should go every six months for a check-up anyway.

I used to be scared of the dentist too but found a great one who explained everything he was doing and really put me at ease. Ask yours to do the same - your smile will thank you for it!

Q MY boyfriend had an operation to remove a pilonidal sinus.

He has been in hospital lying face down for weeks now while he recovers and is getting really frustrated. Is it normal for the recovery period to take this long?

A A PILONIDAL sinus is a very painful condition. It is caused by an ingrowing hair in the cleft of the buttocks that causes a hole or sinus.

This can get badly infected and make you quite ill. Sometimes the only way to fix it is to cut all of the infected tissue away and allow the skin to heal itself rather than stitching it over.

This can take weeks and is very uncomfortable and undignified. Buy him magazines to occupy him and cheer him up with TLC in the meantime.

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Q MY son regularly gets ear infections and I’ve been told he may need grommets in his ears. What does this mean?

A NEVER be embarrassed to ask your doctor to plain things, especially if it is about your child.

Grommets are L tiny plastic I tubes that are inserted into the ear drum. They allow the pressure to balance between both sides and any fluid that has built-up through infection to drain.

It will lead to a big improvement in your son’s hearing and should clear up the problem. He will require a short anaesthetic but the procedure is a very safe one.

Q I FELL and damaged my tailbone. I can’t sit comfortably any more and it is driving me nuts. How long will it take to heal?

A DAMAGE to the tailbone, known as the coccyx, can take a while to heal. Buy a ring cushion to sit on as this will alleviate pressure.

Try not to sit with your legs outstretched and do exercises that will strengthen the buttocks.

It can take up to three months for the pain to lessen but it may be tender to the touch for a few weeks longer.

Q I KEEP getting urine infections. Is it because I take my tablets morning and night, not four times a day?

A SPREADING the drugs out means there is not enough antibiotic in your system to kill the bacteria, causing your infection to come back.

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Commercial opportunity awaits in erectile dysfunction

April 26, 2007

Erectile dysfunction is estimated to affect the lives of 19 million men in the US alone. Yet it was only with the hugely successful launch of Pfizer’s Viagra that the pharmaceutical industry began to take notice of this lucrative market. As the patient population increases, driven by an ageing population, a rise in obesity and erosion of social taboo, the market is expected to swell even further.
‘Content Across the seven major markets, the erectile dysfunction (ED) market grew 3.5% from 2004 to 2005 to total $1.95 billion. Three brands, Viagra (sildenafil), Eli Lilly’s Cialis (tadalafil) and Levitra (vardenafil), marketed by Bayer, GlaxoSmithKline and Schering-Plough, were predominantly responsible for this growth. According to IMS Health, these drugs hold an enormous 96% of the market share. With this majority stake coupled to strong, direct-to-consumer (DTC) driven brand familiarity in the US, it is unsurprising that market entry appears daunting to candidates with new products.

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However, this doesn’t appear to have restricted the evolution of the R&D pipeline: it contains 21 new agents distributed throughout the development stages from preregistration to phase III.

Dong-A PharmTech Co., responsible for the manufacture of PDE-5 inhibitor udenafil, has most recently reported successful phase IIb results. The trial involved 340 patients and featured three different doses and a placebo. All primary endpoints, including vaginal penetration success rates, intercourse completion rates and Erectile Function scores were statistically significant compared to placebo and a dose-dependent effect was also identified. Importantly, all three active dose levels were well-tolerated and the reported side effects were mild to moderate in severity and similar to those generated by marketed products.

Following these results, Dong-A is one step closer to gaining marketing approval for udenafil in the US and EU, replicating its progress in Korea. In the UK, the therapy was launched under the name ‘Zydena’ in late 2005 and by the first quarter of 2006 had mustered 21% of the market share, surpassing sales of Levitra and almost achieving equivalence with Cialis in terms of sales volume.

Exploiting gaps in the market

Dong-A has achieved its position using key strategies that Datamonitor identifies as essential for optimizing entry into the ED market. Although risky, head to head trials are the most transparent way of demonstrating a product’s parity or superiority to a marketed product.

Comparator trials with Viagra demonstrate the superiority of udenafil in terms of a quicker onset of action and medium length of action. Additionally, the endpoints of these trials are particularly relevant. To be competitive, new PDE-5 inhibitors will need to be unique. Key differentiators that would be welcomed by both the prescribing community and sufferers alike include a different time of onset or duration of action.

The uptake of Cialis offers proof of this strategy: it is far greater than that of Levitra primarily because Cialis offers duration of 36 hours whereas Levitra is clinically similar to Viagra, offering only four hours. This extended window of opportunity allows a more natural approach to sexual intercourse.

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Furthermore, varying the time to onset creates niche patient groups. A fast onset of action will appeal to those men who want instant results. Breaking the target population into niche groups reduces competition, focuses marketing and allows advertising campaigns to be tailored to the needs of this group. The market therefore becomes more accessible.

Datamonitor believes that the diabetic population and prostatectomy patients represent other niches suitable for treatment focus within the ED market.

Potential in Western markets

The changing dynamics of the ED market may create further opportunity for udenafil and other pipeline products. Despite a 59% market share in 2005, the growth of Viagra fell by 11% from 2004 to 2005. Pfizer’s product was challenged by Cialis which experienced 53% growth in the same period. The effect was even more pronounced in France where Cialis became the market leader. This trend is expected to be repeated in Germany.

This demise of Viagra is reassuring for new products for two reasons. Firstly, it implies that the ferocity of competition has lessened and secondly indicates that strategies employed by Eli Lilly to differentiate Cialis from its competitors, have been apt.

To fully take advantage of this situation, there are other life-cycle strategies a company should consider. Reformulations of delivery method, for example, may optimize uptake. Although oral tablets are administered with ease and without pain, hepatic metabolism interferes with efficacy. Inhalers, provided they show comparable efficacy, would be easier to use, and would facilitate quicker onset. Additionally, once-a-day formulations may be useful to chronic patients, while a different subset of men can continue to take the agent as and when the need arises.

Should the launch of udenafil into the seven major markets come to fruition, the top four marketed products will all be PDE-5 inhibitors. While currently the most efficacious form of therapy, around 30% of men are unresponsive to this mechanism of action. Until an equally safe and efficacious mechanism of action that can treat the vast majority of patients is found, there will always be unmet need in the ED population. Consequently, Datamonitor expects the opportunities for a product that is not a PDE-5 inhibitor to be considerable. ‘End Intelliext

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Weekender” Cialis promises China marital bliss

April 24, 2007

BEIJING/SHANGHAI (Reuters) - Eli Lilly & Co., maker of impotence drug Cialis, hopes that Chinese couples who might resort to traditional aphrodisiacs or divorce court to resolve sexual problems will seek marital bliss with its own remedy.

The U.S. drugmaker launched a marketing campaign for Cialis in the world’s most populous country on Thursday with the release of a survey showing that 45 percent of middle-aged Chinese couples had experienced erectile dysfunction problems.

Since only one-third of those couples had thought about seeking treatment, Lilly believes that efforts to boost awareness of the problem would increase sales of Cialis, whose long-lasting effects have given it the nickname “the weekender.”
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“This drug is effective, because men are like light bulbs. They can be turned on and off easily. Women are like irons, they need a long time to heat up, but also a long time to cool down,” said psychologist Qiu Xiaolan, brought in as part of Lilly’s media campaign to educate the public.

Cialis, which has been distributed to 5,000 Chinese pharmacies this month, is effective for up to 36 hours, longer than rival drugs on the market, Lilly says.

“It’s a longer window of opportunity,” Eli Lilly China President Jorg Ostertag told a news briefing.

About 35 million Chinese men suffer from some form of erectile dysfunction, Lilly said. Nearly 10 percent of these will eventually look for some sort of treatment, mainly in pharmacies.
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Erectile dysfunction is common among men with diabetes, high blood pressure and high cholesterol levels, and has historically been treated in China with traditional medicines containing herbs or animal parts such as tiger penis and rhinoceros horns.

“Erectile dysfunction has become a serious issue. It not only threatens men’s health, but also challenges family relationships and harmony,” Ostertag said.

A local court in south China granted a divorce to a woman who remained a virgin after four years of marriage due to her husband’s apparent sexual dysfunction, Xinhua news agency reported in October.

More than 10 percent of divorce cases center on sexual dysfunction, Xinhua quoted a judge with the court in south China’s Guangxi Zhuang Autonomous Region as saying.

The Supreme People’s Court has ruled that sexual dysfunction that cannot be cured is proper grounds for divorce, Xinhua said.

Industry estimates for China’s market for impotence drugs range from 500 million yuan to as much as 2 billion yuan a year ($65 million to $260 million).

Cialis, although growing faster globally than Viagra, still lags its rival, which was launched in China by Pfizer, the world’s largest drugmaker, in 2000.

Levitra, an impotence drug developed jointly by Bayer AG, GlaxoSmithKline Plc and Schering-Plough Corp., is also available in China.

Pfizer does not disclose sales figures for Viagra in China but global revenues from of the drug rose 1 percent to $1.7 billion last year.

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Personal Health: Lively libido not only for young

April 18, 2007

Here’s a new word for you: obsolagnium. You may not find it in an ordinary dictionary. But if you are over 50, you may well be familiar with the concept, because it means “waning sexual desire resulting from age.”

In fact, it is rarely age per se that accounts for declines in libido among those in the second half-century of life. Rather, it can be any of a dozen or more factors more common in older people that account for the changes. Many of these factors are subject to modification that can restore, if not the sexual energy of youth, at least the desire to seek and the ability to enjoy sex.

Nor is it just hormones. Addressing only the distaff half of the population, the Boston Women’s Health Book Collective, in its newest work, “Our Bodies, Ourselves: Menopause,” points out: “Our sexual desire and satisfaction may be influenced by our life circumstances, including the quality of our sexual relationships, our emotional and physical health, and our values and thoughts about sexuality, as well as by the aging process and the shifting hormone levels that occur during the menopause transition.”

The same, of course, is true of men. Difficult life circumstances can do much to dampen anyone’s libido. Stress at work or home, looming bankruptcy, impending divorce, serious illness, depression, a history of sexual abuse and a host of medications are among the many things that can put a big crimp in your desire for sex at any age.

As people age, both physical and emotional changes occur that can influence libido. Wrinkles, hair loss, declining muscle mass and accumulation of body fat, among other age-related changes, can make men and women feel less attractive. And if you don’t see yourself as attractive, your brain may respond by dampening any impulse you might have to be intimate with someone.

I strongly suspect that older people who stay in shape physically, keep their brains stimulated and remain interested in a variety of activities are likely to feel more attractive and be more attractive — and thus more libidinous — than those who let themselves go to pot, as it were. I’m not suggesting that people in their 60s and 70s start dressing and acting like 20-somethings, but there are any number of age-appropriate actions that can help people see themselves — and help others see them — as sexually desirable beings.

Of course, illness, both mental and physical, can seriously disrupt a healthy libido at any age. Diseases of the adrenal, pituitary or thyroid glands can diminish sexual desire, as can depression and anxiety. Likewise, several common cancers — especially cancers of the breast, testes or prostate, or the drugs used to treat them — may suppress the desire for sex.

Many commonly administered medications can interfere with sexual desire, performance or both. Among the most frequent offenders are antidepressants and anti-anxiety drugs, blood pressure medications and opioid pain relievers. High doses of alcohol likewise blunt desire as well as performance. Even drugs taken to curb heartburn can curb the desire for sex. In some instances, changing the dose, switching to a different drug or taking a brief drug holiday (say, for the weekend) can boost libido.

While a drug such as Viagra may help a man temporarily overcome disease- or medication-induced erectile dysfunction, it does nothing to increase desire, which is essential for these potency-enhancing drugs to work.

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Knowing how to please each other sustains sexual interest for many long-established couples. But for others, familiarity can breed boredom; they lose interest in doing the same old thing the same old way time after time.

Novelty is a well-established sexual stimulant. An unattached man or woman in midlife or beyond who had all but forgotten about sex meets someone new and attractive, and suddenly the flames of sex are reignited. This can happen, too, to very old people. Stories abound in assisted living and nursing home facilities of elderly widows and widowers whose long-dormant sexuality is reawakened by attraction to a new, albeit equally old, partner.

Of course, changing partners is not a realistic option for those in a long-standing monogamous relationship in which sexual intimacy is just a fond memory.

But there are ways for such couples to introduce novelty — ranging from a change of venue or techniques to an exchange of fantasies or even the introduction of sex toys — that may rekindle sexual feelings.

Women may think that the decline in estrogen at menopause is responsible for their loss of interest in sex. But estrogen loss is only an indirect factor; it can result in vaginal tightness and dryness that renders intercourse painful rather than pleasurable. The use of lubricants and a dildo or more frequent sex can often counteract these effects. But for some women, the use of a vaginal estrogen cream or suppository is necessary to make sex comfortable and more desirable.

But the real libido hormone, for both men and women, is testosterone, which women produce in their ovaries and adrenal glands. As other ovarian hormone levels drop after menopause or surgical removal of the ovaries, so does the amount of desire-boosting testosterone. This has prompted some women to use testosterone replacement therapy to get their sex lives back on track. One drug commonly prescribed off-label is Estratest, a combination of small doses of estrogen and testosterone. Some doctors tailor-make low-dose testosterone preparations for women. A testosterone patch for women has not been approved by the Food and Drug Administration because of insufficient safety data.

Sexual desire among men, too, can be squelched by low levels of testosterone. While there is no official recognition of male menopause, men experience declining levels of hormones as they age — what some experts called andropause — that can affect sexual desire and performance. Other symptoms of this deficiency may include enlarged breasts, loss of body or facial hair, and osteoporosis before age 65.

Testosterone replacement is helpful in restoring the sex drive only of men who have low levels of the hormone. A test of testosterone levels should be done and other causes (besides age) should be ruled out before the hormone is prescribed. Risks include prostate enlargement and prostate cancer.

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Eli Lilly’s profits take a tumble

April 17, 2007

Eli Lilly’s profits fell by a hefty 39% in the first quarter of 2007 on the back of restructuring and acquisition charges, despite recording higher sales of its prescription medicines.

The company’s earnings fell to $508.7 million, or $0.47 per share, from $835 million, or $0.77 a share, a year earlier. These figures were hurt by a restructuring charge of $0.08 per share and a charge of $0.29 a share resulting from Lilly’s $2.3-billion purchase of ICOS Corp.

Excluding these charges, profit was higher than the $0.79 that analysts had forecast, reaching $0.84 a share.

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Revenue in the quarter increased to $4.23 billion, boosted by a jump in sales of 14%. This growth was fuelled by strong sales of the company’s depression drug Cymbalta (duloxetine) and cancer treatments Gemzar (gemcitabine) and Alimta (pemetrexed), as well as consistent growth for its schizophrenia drug Zyprexa (olanzapine). Results also benefited from an average 5% rise in prices.

Lilly purchased ICOS in January in order to gain full ownership of the world’s second-biggest selling impotence drug, Cialis (tadalafil), which the two companies had jointly owned. In the same month, Lilly also paid OSI Pharmaceuticals $385 million for exclusive licensing rights to its experimental diabetes medication.

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ED Pills Are Not A Panacea

April 12, 2007

The development and widespread use of erectile-dysfunction drugs Viagra, Cialis, and Levitra is often viewed as a means to improve or even save relationships. However, according to a new report from Harvard Medical School, these pills offer no help in untangling the emotional and relationship pressures that frequently accompany erectile dysfunction (ED).

For one thing, the medications work only if the man is feeling sexual desire for his partner. If emotional issues are impinging on libido, the pills won’t help.

A man struggling with ED may be so embarrassed that he is no longer willing to attempt sexual activity, and his partner may mistakenly believe that he is no longer attracted to her. She may assume that her partner’s newfound erections are merely a chemical phenomenon, not the result of his interest in her. In these cases, sex therapy may be helpful.

When intercourse is suddenly a possibility again, relationship issues can emerge or resurface, as can dramatic differences in libido. The bottom line is that couples should try to regard these drugs as an opportunity to renew their sexual relationship, while realizing that ED drugs are neither a mandate to have intercourse nor a panacea for every problem in the bedroom.

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Science seeks Rx for lagging female libido

April 10, 2007

The market is saturated with books on how to revive a flagging libido or spice up monotonous sex, and sex therapists say lack of desire is one of the most common complaints they hear from patients, particularly women.

And though there may be legitimate sociological or personal underpinnings to that diminished desire — chronic overwork and stress, a hostile workplace, a slovenly or unsupportive spouse — still the age-old search continues for a simple chemical fix, Cupid encapsulated, a thrill in a pill.

Since the success of Viagra, the pharmaceutical industry has been searching for the female equivalent — a treatment that would do for women’s most common sexual complaint, lack of desire, what sildenafil did for men’s, erectile dysfunction.

Initial trials of Viagra in women proved highly disappointing. The drug enhanced engorgement of vaginal tissue, just as it had of the penis, but that extra bit of pelvic swelling did nothing to amplify women’s desire for or enjoyment of sex.

What is needed for the treatment of so-called female hypoactive sexual desire disorder, researchers decided, is a reasonably safe and effective drug that acts on the central nervous system, on the pleasure centers of the brain.

For a while, many sex therapists and doctors were optimistic about Procter & Gamble’s Intrinsa, a testosterone patch that delivers small transdermal pulses of the sex hormone thought to play a crucial if poorly understood role in male and female libido alike. But in 2005, the Food and Drug Administration refused to approve Intrinsa, declaring that its medical risks outweighed whatever benefits it might offer.

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More recently, another potentially promising treatment for hypoactive desire has been making its way through clinical trials. The compound, called bremelanotide, is a synthetic version of a hormone involved in skin pigmentation, and it was initially developed by Palatin Technologies of New Jersey as a potential tanning agent to help prevent skin cancer. But when male college students participating in early tests began reporting that the drug sometimes gave them erections, the company began exploring bremelanotide’s utility as a treatment for sexual disorders.

Studies in rodents demonstrated that the drug not only gave male rats spontaneous erections, but also fomented sexual excitement in female rats, prompting them to wiggle their ears, hop excitedly, rub noses with males and otherwise display unmistakable hallmarks of rodent arousal.

Inspired by the rodent work, the company decided to give the drug a whirl on women. Results from a pilot study of 26 postmenopausal women with diagnoses of sexual arousal disorder suggest that bremelanotide may well be a mild aphrodisiac.

Responding to questionnaires after taking either the drug or a dummy pill, 73 percent of the women on bremelanotide reported feeling genitally aroused, compared with 23 percent given the placebo; and 43 percent of the bremelanotide group said the treatment augmented their sexual desire, against only 19 percent of those on dummy pills.

Women in the treatment group also were slightly more likely to have sex with their partners during the course of the trial than were those in the control group, although who initiated the romps was not specified.

Larger trials of the drug at some 20 clinical centers around the United States are now under way.

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Fenty Spam Offers Information, But No Cheap Viagra

April 3, 2007

Anyone who uses email is used to getting spam, and lots of it. But from Mayor Adrian Fenty? Now that’s something different.

Last Friday thousands of District residents were treated to an email from the mayor’s office, a new monthly e-newsletter called the “Fentyfile” that highlighted information and initiatives ranging from the 2008 budget to the April 16 Voting Rights March. Of course, I, just like many other thousands of District residents, don’t remember signing up for the Fenty File. Thankfully, the sleuths over at the City Paper called Fenty’s people up, and apparently anyone who has ever used the city’s official website to request services was included in the mailing. Should they not want any more Fenty spam, they’re free to unsubscribe.

I like the idea, so I’m going to keep getting it. Once I start getting last-minute pleas from Fenty for a babysitter on a Saturday night, though, I’m off.

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