Trocaventure

Sometimes, when you get to the basic chemistry of stuff, you will always find the same basic building blocks. So, for example, when you look at most of the basic food and drinks on the market, most of them rely on corn. This is heavily subsidized by the government and so allows us to eat high-calorie food for little money. By the way, the subsidy is why you can buy a mountainous burger for less than the cost of most fresh vegetables. Well, it’s the same with almost all the lotions, gels and creams sold over the counter in drugstores to treat acne. The standard ingredient is benzoyl peroxide. Why is this one ingredient so important?

The bacteria that causes acne lives on the surface of your skin. Under normal circumstances, being exposed to the air keeps their numbers down. But if the glands under your skin start to produce too much oil, the pores will slowly fill with dead skin cells. This creates a warm, dark place where there’s no oxygen. This is a perfect breeding ground for the bacteria. Benzoyl peroxide removes the layer of dead skin cells from the surface and opens up the pores. Once the air is able to get into the pores, the growth of the bacteria is reduced. Over time, if you only have a mild outbreak, the skin will return to normal. With moderate to severe outbreaks, benzoyl peroxide will usually prevent the problem from spreading.

The main advantage of this chemical is that you can buy it as a solution. This is really cheap. Most of the research shows there’s little to choose between the basic chemical and all the branded products over time, i.e. at the end of three months, there’s no real difference in the effectiveness. But some of the combinations work more quickly. So, if you decide to buy one of the products containing benzoyl peroxide, all the extra money does is buy you a few days of looking better. There’s some new research showing the combination with adapalene works faster over three months, no matter how bad the outbreak.
The importance of this research is that it involves almost 4,000 participants. This is an impressive effort. Unfortunately, the design does not give it full credibility, i.e. it’s not a double-blind trial and no placebo was used. The participants were divided into groups. Each group received adapalene, benzoyl peroxide, the combination as a lotion, or a gel as the delivery method. The researchers found the combination as a lotion produced the best results. Some 500 participants dropped out, most complaining about dry skin. This is a standard problem with benzoyl peroxide when starting out the treatment. Using a moisturizer is best. [...]

Over the centuries, we’ve been looking for a magic bullet to give instant pain relief. One of the earliest discoveries was based on the poppy. Depending on how the plant is processed, a range of different drugs can be produced. But there’s always been a problem – the extracts are addictive. Even short-term use can produce destructive consequences. When there were no alternatives, significant numbers of people were hooked, sometimes when only suffering minor symptoms. This led to increasing regulation and control as government grew concerned over the social consequences. The first steps were to make all the opiate drugs prescription only. This has never been a perfect system. Drugs always leak on to the streets when the rewards for illegal distribution are sufficiently high. But with the arrival of more effective alternates, it’s been slightly easier to control the level of addiction. Except control is never perfect. The death rates show more Americans die through the abuse of prescription medication than through the use of heroine and cocaine combined.

We’re the most heavily medicated group of people on the face of the planet. It’s a sad fact more teens experiment with painkillers than cigarettes. Yet every time a state or the federal government suggests tightening up on the prescription of painkillers, there’s an outcry. The libertarians among us believe we all have an absolute right to take whatever drugs we want. There should be no legal limits when the only victims are ourselves. So attempts to discipline doctors for overprescribing the narcotic painkillers often stall. It’s at this point the argument gets mixed up with the problems of end-of-life care.

There’s a strong view in many states that people should be allowed to die with dignity. This means, say, a cancer patient should be given high doses of painkillers even though this will accelerate death. The pro-lifers object saying this is murder, i.e. not death caused by the cancer, but death caused by the drugs. Yet, if lawmakers limit the use of these more powerful drugs without multiple exceptions, people who suffer chronic severe pain may be left without relief. Sometimes the pain from arthritis demands the use of the most powerful drugs. If the discretion of a doctor has been limited, many may be left in pain. [...]

We all know what pain is because we experience it in various forms every now and then. The feeling of the skin being cut, bones broken or joints inflamed cannot be confused with anything else and we know well when there’s pain in our body. Pain is a signal that clearly shows us that there’s something wrong going on inside that needs to be addressed. So it would be right to say that pain is a message to our brain. The nervous system transmits pain signals from the affected area to the brain automatically, which is perceived as the feeling of utter discomfort, burning sensation and dysfunction. Yet, the biggest problem with pain is that it doesn’t go away once you interpret the message and start doing something about it. Just like a phone that keeps ringing on and on after you’ve picked it up, pain is a signal that needs to be turned off intentionally and with effort or it will be there for a really long time. You’ve certainly experienced this unpleasant situation: after getting the right treatment and eliminating the underlying condition pain can still be felt for some time. That’s why some doctors start viewing pain as a separate health condition and in some clinics you will see separate pain management departments that address the problem separately from other departments.

In order to address pain more effectively there’s a need to introduce some basic definitions. In case the pain is caused by an injury and persists for a relatively short period of time it is defined as acute pain. Acute pain tends to wear off with time and doesn’t reoccur unless untreated or a repeated impact is delivered to the affected area. Effective treatment is the key to relieving acute pain since it can make the sensation go away rapidly. And that’s very important because the mere thought that the pain won’t get back is very reassuring. But things are different when it comes to chronic pain. Chronic pain is not characterized by increased severity, it is often less severe than acute pain. Yet, the fact that it tends to reoccur on a regular basis or may persist constantly for days, weeks, months and even years makes it really hard to deal with this type of pain. Chronic pain requires not only actual treatment but also psychological counseling because it can be very hard to deal with it psychologically. [...]

Diabetes is an increasingly common problem as more people carry too much weight around from ever younger ages. Untreated there are two major problems that follow. There’s a reduction in the flow of blood around the body and there’s increasing damage to the nerve endings. As a result, about three-quarters of all diabetic men suffer some degree of erectile dysfunction. The national health agencies confirm a steady statistical trend. All men begin to lose some degree of sexual function as they age but sexual dysfunction shows up in diabetic men ten to fifteen years before healthy men. As a general warning, if the diabetes is not treated and there’s damage to the nerve endings, sexual function does not return. Nerve endings do not regenerate. It’s therefore always in your interests to have the tests for diabetes if you are overweight and then begin to suffer erectile dysfunction. Although it takes several years for the nerve endings to be damaged, it’s foolish to take any risks.

A recent study in Australia has offered the encouraging news that, if you lose 5% or more of your body weight, this is likely to restore sexual function and can also help with the bladder problems likely to afflict diabetic men. The study divided the participants into two groups who tried different diets. The results show the nature of the diet to be irrelevant. As soon as the body weight was reduced, all the participants reported improved sexual performance. The previous studies have examined the use of surgical procedures to reduce weight. Not unnaturally, with a band in place, more weight is lost. This is the first study to show that an ordinary diet producing not less than 5% weight loss is equally effective.

This is a dramatic result because it suggests major invasive surgery may not always be necessary. The decision should depend on a detailed consideration of all the health problems affecting the overweight man. There’s just one problem. The study only involved thirty-one men. This is nowhere near enough participants to produce scaleable results. So, unless and until there’s a properly designed trial involving at least 500 men, we cannot rely on these results. So will there be any further research? [...]

Many centuries ago, a clever inventor had a great idea. Unfortunately, when all the other clever people saw what he had made, they simply copied the work. Our inventor was disappointed. He had been hoping to earn a few dollars. Over time, governments saw this discouraged inventors. If inventors had spent time and money developing a product, they deserved some protection. So the law of patents was born. The way it works is simple. If you invent something new, you are allowed a monopoly. For a fixed number of years, only you can sell this product. This gives you the freedom to keep the prices high and earn back the money you invested during the research and development phase. On paper, this sounds a great system. Inventors are encouraged to bring new products to the market. We get access to the best of these new products. Everyone is happy.

Except, it doesn’t work out so well in practice. What we find is that inventors keep their prices high long after they have recovered their development costs. They just want to make more money and, since no one is allowed to copy their work, we get only one choice: pay or go without. Indeed, patents have become so important, the laws are extended to other markets through international trade agreements. Now a product’s success is not judged by one market, but by how well it sells around the world. This puts great pressure on governments to agree the same system of legal protection in every country. Fortunately, from our point of view as consumers, the rigor of the US laws has not yet been accepted in many countries. This allows other manufacturers to enter the market and offer price competition.

The monopoly in the erectile dysfunction market has just been reinforced. A US court has ordered Teva Pharmaceutical Industries Ltd, a company based in Israel, not to distribute a copy of the erectile dysfunction drugs in the US until 2019. For the three manufacturers with US patents, this is a major victory, but maintaining the high retail prices is a fundamentally unfair result. If you lived in one of the countries with a lower level of protection for manufacturers, you could already buy a generic copy from Teva. If you go to an online pharmacy that also happens to be based in a low protection country, you can have the cheaper drugs shipped to you. But, as a man living in the US, you are forced to pay top dollar if you take a prescription into a brick-and-mortar drugstore. [...]