Every time we come to elections, you probably notice how attorneys are suddenly being debated. The GOP claims they are the spawn of the Devil. Their sole purpose in life is to put all businesses into an early grave. The theme is simple. Every mistake can be evidence of negligence and, without tort reform, we will all suffer. The Democrats sing the song that attorneys are the only thing standing between consumers and predatory businesses. This highlights two quite separate but important problems. First, we have become a very litigious society. If anything goes wrong and we have the money (or are insured), the first reaction to any loss is to blame others and sue them. Consequently, we have one of the most active court systems in the world. Second, there’s a real shortage of adequate laws to protect consumers. This encourages everyone to sue using the law of tort and there we get into long-running cases where attorneys make a lot of money.

Let’s move over to New Jersey where a case has just finished against Roche for their acne treatment. Three claims were heard together. They alleged the drug had caused serious ulcerative colitis. You probably read about this because several Hollywood celebrities were involved as plaintiff and witnesses. The result was a 2 to 1 win for Roche with two of the claims being dismissed by the jury. In reporting this, we can gloss over the fact there are some three-thousand similar claims outstanding. There’s a bandwagon effect. Once word goes around that there’s one claim, other plaintiffs suddenly appear. No matter what the merits of these claims, there are some instructive lessons from other countries.

In Europe, only a qualified dermatologist can prescribe this drug, and he or she is directly responsible for monitoring the progress of the treatment. Patients are usually required to attend the clinic or hospital once a month for a check-up. This ensures a lower risk the drug will be abused by the patients. There’s evidence US patients want the cure now and not tomorrow, so they decide to increase the dosage or extend the period of treatment. Without proper supervision, the drug can therefore cause more damage. The fact there are warnings in the literature given out with every prescription is not helpful. Few people ever read them from start to finish. In New Zealand, there’s very clear research evidence showing low dosages are safe and effective. Such evidence is unlikely to affect the behavior of our teens who are determined to have perfect skin no matter what the cost.

There are always risks of adverse side effects when people abuse drugs. Accutane is a powerful drug and it can damage your body if you take too high a dose or take the recommended dose for too long. Unfortunately, we blame others when we injure ourselves. The fact Roche gives a warning about intestinal and bowel risks is brushed aside. We should only be limited in our claims if the manufacturer can show we actually knew of the risks. Now you see why the GOP thinks attorneys should be locked away. They confuse a simple truth. Accutane is safe so long as you follow the rules.

One of the fascinating things we can do as human beings is put information in little boxes and pretend that’s all there is to know. It’s like when you’re at High School and, for the next test, all you need to know is [insert information]. Once you pass on to the next level, you can often forget whatever you learnt for all those tests. The lid has closed on the box and, unless there’s a crisis, you need never try to remember it again. Well, it’s like the world decided it wanted a smaller box for all the information on sexual problems. In the bad old days, we used to talk about impotence and that included quite a lot of different stuff. Now we only seem to talk about erectile dysfunction and there’s not much to say about that. All the other stuff about an inability to have an orgasm or to ejaculate, low levels of sperm or infertility has disappeared. It’s like we’re not supposed to think about anything like that now we have the erectile dysfunction dugs.

Yet, if you ask the doctors who specialize in this area, they’ll tell you that about two-thirds of the men with severe erectile dysfunction also find it difficult to reach an orgasm, and about 60% find it difficult to ejaculate. To understand what’s happening, we have to understand how drugs are marketed. When a pharmaceutical manufacturer comes to market with something new, it’s vitally important to establish a connection between the brand name and the specific condition it treats. To make this drug stand out, the other diseases and disorders in the same part of the body have to be minimized. The important problem has been solved. The marketers prefer you not to ask about the others.

So, because of this manipulation of the general discussion about sexual problems, the only one we focus on is erectile dysfunction and we do that because we have an effective treatment. Where does that leave us with all the men who cannot ejaculate or no longer have an orgasm? Well, when we do go to the doctor, we fail to report these other problems, and the doctors fail to ask us because there’s no treatment currently available. Yes, sadly, the erectile dysfunction drugs only treat the named condition. They have no effect on the other problems.

When you go back to the original statistics, two-thirds of men with severe erectile dysfunction have no remedy for the secondary problems. They could therefore find hard erections return, but they are still not able to have full sexual intercourse. For older men, children are no longer on the agenda, so their inability to produce children will be less important. Nevertheless, the failure of the pharmaceutical industry to find treatments for these other problems is disconcerting.

The message to take away from this article is to be realistic. If your only problem is the ability to produce a hard erection, Viagra is the best and most reliable drug on the market. In the majority of cases, it will give you back what was lost. But don’t expect Viagra to solve any other problems. It does nothing for fertility, nor does it treat the missing orgasm or the ability to ejaculate.

As a result of steady government pressure, the physical safety of the vehicles on our roads has been rising steadily. When crash and rollover test results name and shame manufacturers, they act to protect their brand image. They have invested in new designs to reinforce the shell to protect the driver and passengers. Now add in the crumple zones where parts of the body collapse and absorb the impact. Finally, you make the car more easily controlled with better suspension and braking systems. All these innovations have seen the number of deaths and serious injuries falling steadily over the last ten years. But there’s little to be pleased about when more than 32,000 people die in crashes every year. The number of people merely injured is frightening. In some age groups, more people die on the roads than through disease. When driving becomes a leading cause of death, something should be done.

The Insurance Institute for Highway Safety recently issued a policy document suggesting how changes in the law might improve safety. Proposals to change the law, particularly to use the criminal law, to force people to act in particular ways is always controversial. There’s a strong libertarian culture that objects when freedom of action is limited. Their knee-jerk response is to argue many of these laws make victimless crimes or where the only people injured are the ones labeled criminals. So let’s take the first proposal to force every state to make safety belt laws primary and to make enforcement high-profile. The libertarians might say they should get to chose whether to wear safety belts. It’s their bodies at risk so their decision. The statistics say that states with effective enforcement consistently have lower fatalities. It’s the same with making motorcycle helmets mandatory. The statistics show hundreds of lives a year would be saved if laws were put in place and enforced.

Now let’s talk about increasing the age at which teens can be licensed to drive. States where the age of licensing is 17 show up to a 30% drop in the number of accidents and a real drop in the number of deaths. Now how about reducing the speed limits? Again the evidence is absolutely clear. Speed kills. It also increases the amount of pollution and burns more oil at a time we should be aiming to use less. Curiously, some states have recently been removing red light cameras as infringing the privacy of drivers, yet they also significantly reduce the accident rates. In 2009, almost 700 people were killed running red lights. Research also shows accidents fall where you replace stop lights with roundabouts. Finally, we need active policing to take the drunk and incapacitated drivers off the roads.

If all the states took this action, the total number of accidents would fall, fewer people would be injured and a lot less would die. If the volume of claims falls, the next round of auto insurance quotes also falls. Fewer payouts in smaller amounts need less premium income. So get on the phone to your local lawmakers. Tell them car insurance rates are the next big political issue and, if they don’t pass some new laws, they will be voted out at the next election.

One of the fascinating things we can do as human beings is put information in little boxes and pretend that’s all there is to know. It’s like when you’re at High School and, for the next test, all you need to know is [insert information]. Once you pass on to the next level, you can often forget whatever you learnt for all those tests. The lid has closed on the box and, unless there’s a crisis, you need never try to remember it again. Well, it’s like the world decided it wanted a smaller box for all the information on sexual problems. In the bad old days, we used to talk about impotence and that included quite a lot of different stuff. Now we only seem to talk about erectile dysfunction and there’s not much to say about that. All the other stuff about an inability to have an orgasm or to ejaculate, low levels of sperm or infertility has disappeared. It’s like we’re not supposed to think about anything like that now we have the erectile dysfunction dugs.

Yet, if you ask the doctors who specialize in this area, they’ll tell you that about two-thirds of the men with severe erectile dysfunction also find it difficult to reach an orgasm, and about 60% find it difficult to ejaculate. To understand what’s happening, we have to understand how drugs are marketed. When a pharmaceutical manufacturer comes to market with something new, it’s vitally important to establish a connection between the brand name and the specific condition it treats. To make this drug stand out, the other diseases and disorders in the same part of the body have to be minimized. The important problem has been solved. The marketers prefer you not to ask about the others.

So, because of this manipulation of the general discussion about sexual problems, the only one we focus on is erectile dysfunction and we do that because we have an effective treatment. Where does that leave us with all the men who cannot ejaculate or no longer have an orgasm? Well, when we do go to the doctor, we fail to report these other problems, and the doctors fail to ask us because there’s no treatment currently available. Yes, sadly, the erectile dysfunction drugs only treat the named condition. They have no effect on the other problems.

When you go back to the original statistics, two-thirds of men with severe erectile dysfunction have no remedy for the secondary problems. They could therefore find hard erections return, but they are still not able to have full sexual intercourse. For older men, children are no longer on the agenda, so their inability to produce children will be less important. Nevertheless, the failure of the pharmaceutical industry to find treatments for these other problems is disconcerting.

The message to take away from this article is to be realistic. If your only problem is the ability to produce a hard erection, Viagra is the best and most reliable drug on the market. In the majority of cases, it will give you back what was lost. But don’t expect Viagra to solve any other problems. It does nothing for fertility, nor does it treat the missing orgasm or the ability to ejaculate.

The common sense answer is an unpleasant sensation caused by anything from a small broken bone to cancer. Obviously, the causes of pain are not the same. Doctors label some pain as acute where you will recover and the pain will go away naturally. So, after proper treatment, a broken bone will be strong again and you can move around like nothing happened. But cancer can be terminal. If you catch it early enough, the treatments can produce a remission and let you lead a good life. Unfortunately the more usual pattern is late diagnosis and treatment that fails to give anything more than temporary relief. Then it’s a painful decline. This is depressing, but it also points to a valuable lesson. With temporary pain, you can take a big dose of a painkiller for a short period. If you have no hope of survival, the priority is now making you as comfortable as possible. This also allows you to take large doses of the most powerful drugs. The problem comes with causes that will persist for years. This is called chronic pain and it requires a different approach.

So here’s a radical idea for you. Pain is a good thing! Indeed, any attempt to make pain go away is dangerous! OK, let’s back up a little. Think of pain as being like an alarm that goes off in your home if a burglar enters. This is a useful warning. If you are home and an NRA member, you can pick up your gun and defend yourself. Now change the burglar to bacteria or a virus that breaks into your body. Although your auto immune system is going to slow down the damage these invaders might cause, the pain is there to tell you to get some real help. Fortunately, medicine has been improving over the centuries. There are now surgeons in ERs to stitch you back together and give you whatever drugs are likely to cure you quickly. Wait, you’re complaining that once pain has done its job and you’ve got the treatment, you want to switch off the pain. Well, that’s not a good idea. Let’s say you take a massive dose of some really powerful painkillers, how are you going to know when the pain actually goes away? How are you going to know whether it’s spreading? One of the most important symptoms to help doctors give you the right treatment is to have a steady stream of information from you about how much it hurts, and whether the pain is going away or spreading. Obviously, if it’s spreading, a different treatment will be required.

So before you start complaining about pain, remember it warns you when you have a problem. The fact you might be receiving treatment for the first problem doesn’t stop you from getting a second problem. That’s one of the reasons why Tramadol is considered one of the best drugs. It reduces the pain to levels easily tolerated and still lets pain do its job, say by warning you about that hot pan you just touched. Until our medical researchers work out how to turn off just the one pain message, you will just have to learn how to live your life with some pain. Tramadol is the best in these situations.

In the good old days when men sold their souls to the company store for sixteen tons and even then only got deeper in debt, there was no technology to warn the miners if gas was building up. The first they might know is an explosion bringing down the roof. Being careful men, they experimented with different ways of testing the air for gas and canaries were the most reliable indicator they found. All they had to do was keep the birds in the mine. If they fell off their perches, there was too much gas around and it was time to evacuate. So much for the history lesson.

Every year, modern medicine directs a lot of money into basic research to look for ways of detecting serious health problems in their early stages. Sometimes, technology is the answer. So many women who go for regular mammograms detect breast cancer early and the treatment is more likely to save the breast and guarantee a long life. In other cases, there are early symptoms that may not, at first sight, have any connection to the more serious condition that appears later. In the case of heart disease, there’s now very clear evidence that erectile dysfunction in younger men is a very clear warning of a possible stroke or heart attack within the next five years.

The explanation for this is slightly complicated. Various types of cells line the walls of our blood vessels. The most sensitive of these are called endothelial. For reasons no one can explain, there are more of these cells in the penis than anywhere else in the body so anything that affects them is going to show up in erectile dysfunction. If you eat a diet containing too much fat, there’s likely to be a build up of plaque on the walls of the arteries. This hardens the cells and prevents the arteries from dilating and contracting. Since the formation of an erection depends on dilation, anything preventing it in younger men signals high risk the same problem will spread to other blood vessels in the body.

If you’re under the age of 50 and you experience a consistent pattern of erectile dysfunction, you should ask a doctor for a full cardiology workup. Indeed, the younger you are, the more urgent it is you have the tests done. But if you’re older, there are fewer risks. It’s reasonably safe to buy Viagra online and rely on that to solve the problem. That said, we’re all aware of the so-called epidemic of obesity. That’s too many men carrying too much weight. No matter what your age, you should think about changing your diet. One of the most common causes of a plaque build-up is eating too much carbohydrate in your food. The evidence shows men find erectile dysfunction is less of a problem if they lose weight. This should not be a big deal. It’s just a matter of eating a low-fat diet in smaller portions. If you can add in a little exercise, so much the better. If this is too much of a challenge, there’s always Viagra but, if your weight does continue increasing, it may only be a short-term fix. Losing weight is better.

It might sound an odd way of starting off a discussion of pain, but could you solve a math problem if you didn’t know any math? Now we come to the point. If you had the right software on a piece of computer hardware, you wouldn’t need to know any math. You could just feed in the question and the answer would come out. Well that works great if you have the right software and the machine can give you the results you need. Hey, why did you need to solve the math problem in the first place? Was it for a class test? Does your school allow the use of math packages? Well, to avoid getting too complicated, let’s assume this is for some other purpose. Can you use the answer if you didn’t understand the question?

Now let’s switch words. Instead of math – a subject so unpleasant, only geeks like it – let’s talk about pain. What’s to understand? This is an unpleasant sensation and when it doesn’t stop, you take a pill. Well, yes, this may work well when the pain first starts, but is this the answer you want? You’re getting frustrated now. What’s to know or worry about if the pill makes the pain go away?

OK, we need to start again. One of the problems with most drugs is they work really well when you start taking them. Your body is surprised by the strange new chemicals in your blood and it does nothing to stop these chemicals from working their magic. But these chemicals are foreign invaders and your body’s auto immune system is designed to react when the blood is contaminated. Notice this is an automatic process. You can’t tell your body, “Hey, these chemicals are doing me good so don’t mess with them!” As time passes, you build up resistance. Doctors call this tolerance. No matter what the name, the effect is the same. The drugs slowly stop working. This leaves you with a choice. Either you increase the dose or you switch to a stronger drug or you find another way of dealing with the problem. Well, what’s the problem with just taking more pills? This can very quickly lead to dependence. As your body continuously adapts to these chemicals, you can find yourself trapped if you later want to stop. The withdrawal symptoms can be much worse than the original problem. Just as important, can you afford the cost of all these drugs over the years? Let’s assume $1 per pill and three pills a day. That’s $1,095 a year. Now start taking more pills or watch the retail price increase.

So there’s a place for Tramadol. For short-term pain relief, there’s nothing better on the market, even for severe pain. Equally important, it’s significantly less addictive than the opiate painkillers. At low doses, you can take Tramadol for quite long periods of time and still be able to stop without too many problems. But it’s far better to understand the questions posed by pain so that you can learn the answers without having to rely on a pill. Just as you cannot always rely on computer hardware to solve your math problems, you cannot always rely on drugs to solve your pain problems.

Let’s start off with a definition of a myth. Essentially, it’s a lie we tell ourselves to hide our fear. Suppose we’re frightened of lightning. No problem! We’ll invent a god who walks around the sky and, if he gets upset with anyone, he lets go a bolt or two. Why is this a good idea? As a priest in this new religion, all you have to do is keep the god happy by worshiping, giving me offerings and buying my comic books. So long as the god is happy, you will then be safe. No more fear! Thor rocks! Now let’s apply this to acne. As parents, we feel the need to prepare our children for all the bad stuff that’s likely to happen to them. So we tell them the story of acne. This is a disease so terrible that most affected end up looking like a toad with warts – obviously you want to keep the fear to Disney animation level so mention Princes turning into them and Princesse Fiona secretly being a green-skinned ogre at night. All this recognizes the new social reality. Only those with a perfect skin are acceptable. Everyone else is out of the magic circle in school and only allowed to mix with goths and nerds. To cushion the blow of having unattractive friends, we then tell them the really big lie – that they soon grow out of it and it will never affect them as adults.

The current estimate is that about 15% of the adult population suffers acne. That’s millions of people. Fortunately, the majority of sufferers are women and there’s a big market for selling concealer makeup, i.e. heavy foundation creams and a powder to put on top. Even metrosexual men are reluctant to wear obvious makeup. So why is acne affecting more adults? Here we get into yet more myths as self-appointed experts muscle their way on to television and radio stations to sell their miracle products or latest book detailing Obama’s acne and his loss of popularity. Their explanations range from too much stress in our lives to the diet we eat. This would be helpful if there was any scientific evidence to link either stress or diet to acne. Except there’s no such evidence. It’s all just more myths.

So what can or should we do as adults. For men, washing twice a day with an unmedicated soap is enough to clear the pores. If you want a cheap alternative to soap, use benzoyl peroxide in small amounts. Using too many products to clean your skin can dry it out and make acne harder to beat. For general health and the improvement of your skin, you should also drink less alcohol, quit smoking and avoid a smokey atmosphere. For women, using an oral contraceptive can reduce the hormone level. If this is not acceptable on moral grounds, then the usual self-help approaches to keeping the skin clean are the best. If all else fails and your appearance is so important, Accutane is available. As a woman, remember to take the strongest possible measures to prevent pregnancy. There’s very clear evidence Accutane does cause birth defects in the majority of cases. No one can pass this medical consequence off as a myth.

Let’s start off with a definition of a myth. Essentially, it’s a lie we tell ourselves to hide our fear. Suppose we’re frightened of lightning. No problem! We’ll invent a god who walks around the sky and, if he gets upset with anyone, he lets go a bolt or two. Why is this a good idea? As a priest in this new religion, all you have to do is keep the god happy by worshiping, giving me offerings and buying my comic books. So long as the god is happy, you will then be safe. No more fear! Thor rocks! Now let’s apply this to acne. As parents, we feel the need to prepare our children for all the bad stuff that’s likely to happen to them. So we tell them the story of acne. This is a disease so terrible that most affected end up looking like a toad with warts – obviously you want to keep the fear to Disney animation level so mention Princes turning into them and Princesse Fiona secretly being a green-skinned ogre at night. All this recognizes the new social reality. Only those with a perfect skin are acceptable. Everyone else is out of the magic circle in school and only allowed to mix with goths and nerds. To cushion the blow of having unattractive friends, we then tell them the really big lie – that they soon grow out of it and it will never affect them as adults.

The current estimate is that about 15% of the adult population suffers acne. That’s millions of people. Fortunately, the majority of sufferers are women and there’s a big market for selling concealer makeup, i.e. heavy foundation creams and a powder to put on top. Even metrosexual men are reluctant to wear obvious makeup. So why is acne affecting more adults? Here we get into yet more myths as self-appointed experts muscle their way on to television and radio stations to sell their miracle products or latest book detailing Obama’s acne and his loss of popularity. Their explanations range from too much stress in our lives to the diet we eat. This would be helpful if there was any scientific evidence to link either stress or diet to acne. Except there’s no such evidence. It’s all just more myths.

So what can or should we do as adults. For men, washing twice a day with an unmedicated soap is enough to clear the pores. If you want a cheap alternative to soap, use benzoyl peroxide in small amounts. Using too many products to clean your skin can dry it out and make acne harder to beat. For general health and the improvement of your skin, you should also drink less alcohol, quit smoking and avoid a smokey atmosphere. For women, using an oral contraceptive can reduce the hormone level. If this is not acceptable on moral grounds, then the usual self-help approaches to keeping the skin clean are the best. If all else fails and your appearance is so important, Accutane is available. As a woman, remember to take the strongest possible measures to prevent pregnancy. There’s very clear evidence Accutane does cause birth defects in the majority of cases. No one can pass this medical consequence off as a myth.

In theory, everyone is the same except, obviously, they are not. Let’s start with age. Seniors may be physically active but, look inside, and you will find their liver and kidneys are not working as well as in days gone by. This means it takes longer for impurities to be filtered out of the blood. For these purposes, drugs are impurities. So, when an older person takes any medication, it’s processed through the stomach into the bloodstream and then circulates for longer. This means an older patient must either take a smaller dose or the time between doses must be longer. If such simple steps are not taken, it’s easy for older people to have peaks of drug concentration close to overdose levels. Adverse side effects are more common.

At the other end of the age scale, most drugs are not tested on children and young adults. It’s not considered ethical to expose underdeveloped human bodies to the risk of injury unless there’s a clearly identified need. As a result, doctors are often left guessing whether to risk prescribing drugs and opting for the lowest possible doses. Now we come to the politically incorrect question of body weight. Without getting into the speed of your body’s metabolism, thin people should receive smaller dose than those carrying more weight. Doctors often use a formula relating grams to pounds of weight.

A further difficulty is that pain is very subjective. Some people seem to be able to accept levels of discomfort that would have others rolling on the floor in agony. This is partly physical and partly psychological. As we grow up, we learn from our parents and peers how we are supposed to react when injured. Boys are supposed to be tough. It’s OK for girls to cry. Stereotypes are difficult to shake. This makes it very difficult to assess how much pain anyone is feeling. All a doctor can do is ask and try to place the answer on a scale of 1 to 10 where 10 is the worst pain imaginable. The louder the complaint, the higher the dose or the stronger the drug. For the doctor, it’s all trial and error until the patient admits to feeling less pain. Against this background, it’s interesting to see some new research into using a new technique on an MRI scanner to measure pain. Arterial spin seems to show changes in the parts of the brain associated with pain. If this research can map the brain to show more precisely which part of the brain to monitor, it may be possible to produce a more objective method for measuring pain.

This would have immediate benefits for the patient, always giving the right dose. It would also be good for society because it would reduce the risk of drug abuse. As it is, patients who are developing a dependence can exaggerate their reports of pain and get additional tablets to feed their habit. This is less of a problem for drugs like Tramadol which are significantly less addictive than the opiates. But even Tramadol can be abused if people take it for too long at too high a dosage. No matter what the diagnosis, it’s always better to have the right dosage for your age and physical size.