Archive for August, 2008

A book review of “Insomniac” by Gayle Greene

Tuesday, August 26th, 2008

I want to talk about the new book about ambien. Gayle Greene has the distinction of being a non-professional member of the American Academy of Sleep Medicine (AASM). She wins this prize even though not a medical researcher because she is the “patient representative” on the board of the American Insomnia Association, which operates within the AASM’s umbrella. In her spare time (sic), she labours at the Scripps College, Claremont California as Professor of Literature and Women’s Studies. This latest tome (quite heavy at 520 pages) adds to her impressive resume of academic publications. This is a highly personal account by an articulate and intelligent woman who has been afflicted by insomnia for most of her adult life. In one sense, the only person who can really tell you what it is like in a foreign country is one who has been there. For those of us who have always been able to sleep without difficulty, insomnia is like a foreign country, and the idea of having to use a medication like Ambien as the passport to get into sleep is alien. Conventional wisdom always says that insomnia is somehow related to anxiety or stress levels, perhaps aggravated by drinking too many cups of real coffee. Greene comes up with a simple and practical explanation of what insomnia is. Insomnia means nothing more than you cannot get the number of hours of sleep you need to feel good about yourself and function efficiently. There is no reason for this. It is nothing more than a failure to sleep. There should be no pejorative implication. To use stress as an excuse is to blame the person for being weak or neurotic when there is no reason to blame yourself or anyone else. Instead of looking for some psychological explanation or a less judgemental physical cause, we should just accept that it happens to about 20% of the population at one time or another during their lives. Why bother to spend Government money on researching the cause of a condition when private capital has already invented Ambien as a cure for it? She debates what we really understand about cause and effect. It is so easy to get the cart before the horse, or should that be the other way round? Perhaps conventional wisdom has also got things back-to-front. Instead of stress and anxiety being the cause of insomnia, perhaps living with insomnia makes you stressed and anxious. Who is to say in these more modern times, that we did not have disturbed sleep patterns in past times living on the land? Folk tales may tell us that we went to sleep when dusk fell and waited for the cock to crow before waking. But was that actually the case?Such a vast number of people yet so little is spent on researching the condition and its causes. Greene comments that the National Institutes of Health in the United States spent less than $20m in 2005, whereas Sanofi-Aventis spent more than $120m promoting Ambien in the same year. This is neither to praise nor condemn Ambien. It is all a question of priorities. Who can say what the real biological norms were before electricity came along and gave everyone the chance to live through the darkness. As it stands, no researcher can actually explain why we have to sleep nor why some people sleep more than others. Greene describes everything she has tried over the years from relaxation therapies to medication like Ambien, but concludes that, like any intimate relationship, how we relate to sleep is always personal. She is a passionate advocate for greater patient power to persuade disinterested bodies to research insomnia.

No-one takes any notice of adverts, do they?

Thursday, August 21st, 2008

Everydays the millions of dollars are being spent on what we cass social medical advertisement. In other countries, such advertising is often banned. Advertising to the medical profession is, however, universal - companies need to inform doctors of the products and their use.

It is easy to dismiss advertising as having little effect on consumer behaviour which is, of course, why companies spend so much on advertising campaigns. In the medical field, the adverts are intended to achieve specific goals:

  • to increase brand name awareness;
  • to accept links between everyday experiences and medical accidents;
  • to understand that the branded medications will remove the causes and return you to normal (whatever that is).

The first adverts appeared in eighties the FDA made a ban to research the effect of the adverts on the public. In 1985, the moratorium was lifted because of fears that it was interfering with freedom of speech. Nowadays we have very balanced ads. The FDA monitors compliance and can instruct a company to withdraw any advertisement it feels does not comply. Interestingly, some pharmaceutical companies now spend more on direct-to-consumer advertising than doctor advertising. Their view is that consumers can affect doctor behaviour.

These simple statements are often combined with personal testimonials and confirmation that use of the medication avoids the feared outcome, in this case, a failure to penetrate or maintain the erection after penetration. This tends to be the core appeal. If erectile dysfunction is the problem, cialis helps you to function normally again. The medication is packaged as a means of emotional security. Trust the pills to get you back to normal. People are praised because they cared about themselves and the effect their condition was having on their partners. By introducing others as victims, guilt at not getting the “cure” is increased - cialis is life-enhancement for both partners. To support this, people are encouraged to begin the art of self-diagnosis and health management. In the advertisements you always see only several symptoms of the illness, bur you believe that illness in the ad is the same as yours. It is uncommon to find the price of the medication mentioned, or any information about whether it is available on health insurance plans.

There is obvious that this advertising educates the public about their options when faced by health problems and teaches them to believe that taking a pill is the best solution. When that medication is only available on prescription, it promotes business to the doctors. Add to this the fact that the word-of-mouth advertising for cialis has been and remains very strong, and it is easy to understand why this medication has taken so big a slice of the market so quickly.

In the area of ED, the advertising for cialis runs through a number of different forms. Like any prescription medication, it is aimed at relieving the symptoms of a medical condition. The wording proclaims, “It works!” as if that explains all the benefits of the medication.

What to do about neuropathic pain?

Tuesday, August 19th, 2008

There has been a wealth of research into what causes pain. Pain is a symptom that something in your body is wrong. Researchers can describe in detail how the sensation is transmitted from its source to the brain so we become aware of the problem and can take action to treat it. Unfortunately, despite our better understanding of what it is, actually relieving the pain remains a challenge. If we are dealing with a non-fatal physical injury, we can set the broken bones, stitch up the wounds and wait for the body to repair itself. If the pain becomes more acute due to a terminal condition, the issues of addiction and, to some extent, adverse side effects are less relevant. The humanitarian need is to make a person as comfortable as possible during the final period of life. But long-term neuropathic pain represents a completely different set of challenges.Neuropathic pain is not properly understood and, consequently, not routinely diagnosed. It is caused by a lesion or dysfunction to the peripheral or central nervous system, i.e. the nervous system itself is damaged. The cause may be a physical injury or a disease may affect the way it works. Consequently, the pain may be caused by the damage to the nervous system itself or the system may be sending out general distress symptoms or, in some cases, false pain messages. Physical injuries to the nervous system are very difficult to treat because nerve tissue does not easily regenerate. In other cases, researchers do not properly understand why an apparently undamaged system may malfunction. Because the system that transmits and controls pain sensations may be damaged or not working properly, people often react to treatment in a wide variety of unpredictable ways. For the same reason, many prove more vulnerable than usual to adverse side effects. But the consequences of not providing effective pain relief can be serious. People who experience pain over a longer period of time are more likely to become depressed and may find it difficult to remain in paid work.

But ultram is an atypical opioid and its ability to relieve pain of all kinds makes it one of the first-response medications on the online market for the treatment of neuropathic pain and any of its derivatives. Doctors must take care to avoid adverse interactions with other medications, particularly the two classes of antidepressants: the Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MOIs). The other most common problem is that anyone with a history of seizures or who is being treated with medications that lower the seizure threshold may be at an increased risk of seizures if they are taking ultram. However, ultram is generally preferred in cases of neuropathic pain because there are fewer problems of dependence so long as people use the medication as prescribed. In the end, the main conclusion we can make from this is the fact that ultram has much more advantages than disadvantages.