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Herb Adulteration: What’s Really In That Supplement?

As early as 2006, I used to be able to write monthly about US FDA warnings on erectile dysfunction supplements being found adulterated with prescription drugs such as sildenafil, the phosphodiesterase-5 inhibitor found in Viagra. These adulteration episodes raised the question of how many anecdotal reports of herbal products “working” had to do with them containing approved medicines.

So common was this practice that FDA created a site in 2008 that was dedicated to this problem: Hidden Risks of Erectile Dysfunction “Treatments” Sold Online. Indeed, these products were more commonly encountered from online retailers and not in health food stores. Other similar practices include bodybuilding supplement being spiked with anabolic steroids and weight loss supplements being adulterated with sibutramine (formerly Meridia), an anorectant removed from the market last year after showing increased incidence of heart attacks and stroke in patients with preexisting cardiovascular disease.

The herbal industry, led by the American Herbal Products Association (AHPA), aimed to clean up this problem and launched an initiative called, Spurred by an FDA letter to the industry on 15 December 2010 of increased scrutiny on the adulteration problem, AHPA actually encouraged FDA to Read more »

*This blog post was originally published at Science-Based Medicine*

Pain Medicines Used More Frequently By Men With Erectile Dysfunction?

The use of Motrin, Aleve and other non-steroidal anti-inflammatory drugs (NSAIDS) is associated with erectile dysfunction, according to a study by scientists affiliated with Kaiser Permanente.

cantgetenough 300x200 NSAIDs Linked to Erectile DysfunctionThe apparent link surprised the scientists. They had hypothesized that the commonly used pain-killers would actually reduce the risk of erectile dysfunction since NSAIDS protect against heart disease, which has in turn been linked to the troubling condition.

To reach their surprising conclusion, Steven Jacobsen and colleagues used data from Kaiser’s HealthConnect EHR, an associated pharmacy database, and self-reports about NSAID use and erectile dysfunction from an ethnically diverse population of 80,966 men between the ages of 45 and 69.

After controlling for age, ethnicity, race, body mass index, diabetes, smoking status, hypertension, high cholesterol and coronary artery disease, the scientists found that men who used NSAIDS at least 3 times per day for at least 3 months were 2.4 times more likely to experience erectile dysfunction than those who did not consume them on a regular basis. The link persisted across all age categories.

Remarkable in its own right was the finding that overall, 29% of the men in the study reported some level of erectile dysfunction.

The authors emphasized that their findings do not prove that NSAID use causes erectile dysfunction. For example, the study findings could have been confounded by factors not considered by the scientists (such as subclinical disease or the severity of the comorbid conditions that were studied), and the chance that NSAID use was actually an indicator for other conditions that caused erectile dysfunction.

In addition, the scientists recognized that their study had some limitations. These included an inability to temporally link NSAID use and the development of ED, and possible selection bias.

As a result, they cautioned men against discontinuing NSAIDs based solely on the findings of their study. “There are many proven benefits of non steroidals in preventing heart disease and for other conditions. People shouldn’t stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it’s worth a discussion with his doctor,” Jacobsen said in an interview.

The write-up appears in the Journal of Urology.

*This blog post was originally published at Pizaazz*

When Your Health Hinders Your Love Life

This is the time of year when stores are filled with red hearts and other reminders that Valentine’s Day is approaching. It’s a mood booster, not to mention a nice break from all that winter grey (at least up here in Boston). After all, what would life be like without romance, love — and sex?

Unfortunately, a variety of health problems — as well as some of the treatments for them — can get in the way of sexual desire and functioning. Here’s a quick look at some of the main sources of trouble and suggestions about what to try first. If these initial strategies don’t work, have a heart to heart with your doctor about what to do next. There may not be a quick fix for health-related sexual problems, but there are steps you can take to help ensure that you can still enjoy a love life while taking care of the rest of your health.


Arthritis comes in many guises, but most forms of this disease cause joints to become stiff and painful. The limitations on movement can interfere with sexual intimacy — especially in people with arthritis of the knees, hips, or spine.

One common solution is to try different positions to find a way to make sex physically more comfortable. Another option is to take a painkiller or a warm shower before sex to ease muscle pain and joint stiffness. Or try a waterbed — which will move with you.

You can read more online by viewing this helpful article posted by the American College of Rheumatology.


Cancer treatment may have long-term impact on sexual desire and functioning. Surgery or radiation in the pelvic region, for example, can damage nerves, leading to loss of sensation and inability to have an orgasm in women and erectile dysfunction in men. Chemotherapy can lower sex drive in both men and women. Read more »

*This blog post was originally published at Harvard Health Blog*

Testosterone For Anti-Aging In Men: A Medical Fraud?

On the car radio, I have several times happened upon “infomercial” programs touting the benefits of testosterone replacement therapy for men, broadcast by doctors who specialize in prescribing the drugs. They have lots of wonderful stories about men who feel younger, happier, and more vigorous because of their macho remedies. It’s a tribute to the power of the placebo.

I have been reviewing John Brinkley’s goat gland scam for a presentation on medical frauds. In an era before the isolation of the hormone testosterone, Brinkley transplanted goat testes into human scrotums in an attempt to treat impotence and aging. We are more sophisticated today — but not much. Longevity clinics and individual practitioners are offering testosterone to men as a general pick-me-up and anti-aging treatment. Their practice is not supported by the scientific evidence. Read more »

*This blog post was originally published at Science-Based Medicine*

An Important Tip For Men Who Use Viagra

The medical journal Mayo Clinic Proceedings recently contained some clinical pearls that I wanted to pass on to my men readers who take medication for erectile dysfunction (ED). They reported on a healthy 67-year-old male who took two 25mg doses of Viagra (sildenafil) but still did not get erections. He was frustrated and inquired about other treatments for ED.

The article reported that patients often take Viagra and other phosphodiesterase type 5 inhibitors (Cialis, Levitra) incorrectly. To be effective, Viagra must be taken on an empty stomach at least one hour before intercourse. Research has shown that approximately half of patients who don’t respond to Viagra will have success when they take it properly. The dose can go up to 100mg, but there is no need to increase the medication until the patient learns how to take it.

So there you have it. Take it on an empty stomach at least one hour before sex.

*This blog post was originally published at EverythingHealth*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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