Erection Problems: Many Causes

Erectile dysfunction (ED) is the continued inability to get or maintain an erection that is firm enough for a man to have intercourse. You may be unable to get an erection at all, or you may lose the erection during intercourse. Erection problems are common in adult men and almost all men experience temporary difficulty getting or maintaining an erection. For others it is an ongoing problem. If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem. An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal
process can result in erectile dysfunction.

Common causes include:

• Diseases and conditions such as diabetes, high blood pressure, heart or thyroid conditions, poor circulation, low testosterone, depression, spinal cord injury, penile nerve damage (for example, from prostate surgery), or neurological disorders (such as multiple sclerosis or Parkinson's disease)

• Certain medicines such as blood pressure medicines (especially beta-blockers) and antidepressants

Sometimes lifestyle changes can improve erectile function. These are:

• Elimination of alcohol, tobacco and illegal drugs

• Increased rest and time to relax

• Exercise and a healthy diet

• Open communication between both partners in a sexual relationship

• Counseling by a professional

Physical causes are more common in older men, while psychological causes are more common in younger men. Call your doctor if you have difficulty having or keeping an erection more than 25% of the time or if you have noticed a change in your ability to obtain an erection after starting a new medicine. Your doctor will take a complete medical history, perform a physical examination, and order tests. These tests may include:

• Urine analysis

• Blood tests, chemical tests (including Prostate Specific Antigen-PSA) and tests to determine the level of sexual hormones in the body

• Penile ultrasound (to evaluate for blood vessel or blood flow problems)

• Night-time penile monitoring using a medical device to see if

you are having adequate erections during sleep. (This helps to
determine if your problem with erections is psychological or
physical)

• Neurological testing

• Psychological testing of behaviors

The treatment depends on the cause. For example, if you have a hormonal imbalance, your doctor will prescribe medicine to treat the underlying cause. If your doctor notes a deficiency of male hormone, testosterone replacement therapy can be prescribed with one of the following:

• a skin patch

• gel containing testosterone

• periodic injection of testosterone

There are many other treatment options also available. These include medicines taken by mouth, injections into the penis, vacuum devices, and penile implant surgery.

Viagra, Levitra, and Cialis are three medicines prescribed for erectile dysfunction caused by either physical or psychological problems. (See Additional Information below).

If pills do not work, other options are available, such as Alprostadil (FDA approved in 1995) that is injected into the penis or inserted as pellets into the urethra. For some patients, doctors may recommend a vacuum pump which draws blood into the penis to create an erection.

If other methods do not work, a penile implant (prosthesis) is considered. It is surgically implanted and works well on demand. In about 10 percent of the cases, a patient may have a minor or major complication requiring corrective surgery, treatment for infection, and in some cases, removal of the device. If the implant has to be permanently removed, the ability to have natural erections is completely lost.

Financial Ties Are Cited as Issue in Spine Study

Some of the nation’s most prominent spine surgeons hailed it as a medical breakthrough.

In a study of nearly 240 patients with lover bag pain, the doctors said that the Prodisc, an artificial spinal disk, had worked much better than conventional surgery in which patients’ vertebrae were fused.

“As a surgeon, it is gratifying to see patients recover function more quickly than after fusion and return to their normal activities more easily,” Dr. Jack E. Zigler, a well-known spine specialist and one of the study’s lead researchers, said in a 2006 news release announcing the latest results of the Prodisc clinical trial.

As it turns out, Dr. Zigler had more than a medical interest in the outcome. So did doctors at about half of the 17 research centers involved in the study. They stood to profit financially if the Prodisc succeeded, according to confidential information from a patient’s lawsuit settled last year.

The companies behind the disks and the surgeons who were willing to comment say the researchers’ financial interests had no impact on findings of the research, which they say have been published in various peer-reviewed medical journals. The Prodisc, used on thousands of patients, has been shown to benefit many people with back pain, they say. It is unclear, however, whether the disk’s maker fulfilled its legal obligation to inform the food and drugs administration of the researchers’ financial interests before it used the study’s results to approve Prodisc in August 2006.

Synthes, the current manufacturer, said it would not comment on whether the F.D.A. had been fully informed of the researchers’ interests. The F.D.A said it was investigating the matter.

In the study results submitted to the F.D.A., moreover, an unusually large number of patients were not included, and some of those patients have said they fared poorly. As a result, some patients and doctors critical of the research say the study may have cast the Prodisc in an overly flattering light.

The way the Prodisc was tested and approved provides a stark example of conflicts of interest among clinical researchers — conflicts that are seldom evident to doctors and patients trying to weigh the value of a new device or drug. Instead of serving as objective gatekeepers who can screen out potentially harmful or ineffective new devices or drugs, some medical experts say, clinical researchers with conflicts may have incentives to overstate the value of a new product for patients.

For better or worse, doctors in this country frequently have financial ties to the companies whose devices or drugs they recommend to patients. But in the case of the Prodisc clinical trial, as with any clinical research, the doctors were supposed to be acting not as advocates for the product but as objective scientists studying whether the disk was safe and effective enough to be widely sold and used in the United States.

“The surgeons themselves are guilty of being insufficiently critical of products and techniques they are developing,” said Dr. Richard A. Deyo, a medical professor at Oregon Health and Science University. “More people are interested in getting on the gravy train than on stopping the gravy train.”

One Prodisc study patient who says the surgery left her worse off, Patricia Kennedy, asserts her surgeon “seemed more concerned with the prospects for the Prodisc than for her medical care,” according to the lawsuit settled on undisclosed terms last year. The surgeon, Dr. Richard A. Balderston, who practices in Philadelphia, was one of the researchers with a financial interest in the disk. He referred questions to his lawyer, J. Scott Kramer, who declined to comment. Ms. Kennedy and her lawyer also declined to comment.

Most of the 11 other Prodisc investor-surgeons who were asked to comment also declined. But Dr. Kevin Foley, a Memphis surgeon involved in the study, says he put $20,000 behind the Prodisc because he considered it a promising technology. He said one patient, a schoolteacher, had trouble standing before her Prodisc but was able to go hiking afterward.

But Dr. Foley said some patients do not do as well after surgery and he favored spinal fusion
for most.

Spinal Surgery Questions

The field of spinal surgery and devices has been riven with questions about the effectiveness of treatments. Some doctors and insurers say there is too little clinical evidence showing that back surgery works for most people, whether they get traditional fusion surgery or have a disk replaced.

Even though fusion surgery continues to be the treatment of choice, there is substantial debate over how many patients actually benefit from it.

Now, artificial disks are drawing skepticism. Thousands of patients worldwide have received the Prodisc, which sells for about $10,000 in the United States. But medicare and several commercial insurers generally refuse to pay for the surgeries, which can cost tens of thousands of dollars.

And many of the Prodisc investor-researchers are now focusing their attention on newer spinal devices — often for companies with whom they also have financial ties. Dr. Zigler, for example, is a researcher for a new spine-stabilizing device made by Applied Spine Technologies, where he serves as a paid member of the company’s scientific advisory board.

But while doctors may easily move on to the next new thing, some patients are still coping with the aftermath of Prodisc procedures.

Calvin Timberlake, a 50-year-old former forklift operator who lives just outside Victoria, Tex., had a Prodisc implanted in his spine four months after the F.D.A. approved it; his surgeon was not involved in the clinical trial. He says the Prodisc subsequently came apart, forcing him to undergo a second emergency surgery to have it removed.

Mr. Timberlake, who says he remains in severe pain, is suing Synthes, but not the doctor, whom he does not blame for his problems. A spokesman for Synthes declined to comment.

Dr. Charles Rosen, a spine surgeon at the University of California, Irvine, was not involved in the Prodisc trial. But he provided his expert opinion to Patricia Kennedy’s lawyers and has reviewed the medical records of some of the other patients who are dissatisfied with their treatment. He is among a growing number of specialists who say the relationships between some prominent spine surgeons and the device industry have become too cozy.

“Industry’s goal is to make a profit for its shareholders, not to advance medicine,” said Dr. Rosen, who in 2006 saw a need to start a group called the Association for Ethics in Spine Surgery. It now includes 85 specialists who say one of their aims is to warn the public about industry influence on medical practice.

Investing in a Start-Up

Prodisc was developed by Spine Solutions, a privately held start-up company in New York that was jointly founded in 1999 by a German medical instrument maker and a New York investment firm specializing in orthopedics, Viscogliosi Brothers.

Anthony Viscogliosi, one of the three brothers running the firm, served as Spine Solutions’ founding chief executive and its chairman. The Viscogliosi firm operated a number of investment funds whose main asset was Spine Solutions.

Dr. Zigler, a spine surgeon at the Texas Back Institute, was the first doctor in the United States to perform the disk surgery in October 2001. Texas Back, widely considered one of the nation’s leading private practices in spinal medicine, has been among the most aggressive in advocating new devices like artificial disks.

The confidential documents show that Dr. Zigler invested at least $25,000 in early 2002 in a Viscogliosi Brothers fund created to finance Spine Solutions.

A venture capital fund run by the Texas Back Institute, meanwhile, had invested an additional $75,000 in the same fund. Other doctors at Texas Back were also investors, putting in an additional total of $70,000.

Dr. Zigler and the Texas Back Institute declined to comment except through a statement attributed to Dr. Zigler. “The integrity of clinical research trials is core to the successful advancement of spine and neck care and at the heart of Texas Back Institute’s commitment to provide leadership in the field,” it said, in part.

Other well-known surgeons who were researchers in the study and investors in the Viscogliosi funds included Dr. Frank P. Cammisa Jr., the chief spine surgeon at the Hospital for Special Surgery in New York. By the end of 2001 Dr. Cammisa had invested a total of $250,000. The hospital itself owned stock directly in Spine Solutions.

The hospital says that it no longer invests in companies whose products it is researching but that patients participating in the Prodisc study were told about the hospital’s and Dr. Cammisa’s financial interests. Through a hospital spokeswoman, Dr. Cammisa declined to comment.

Other prominent spine surgeons involved in the Prodisc research who also invested at least $100,000 with Viscogliosi Brothers included Dr. Balderston, Dr. Thomas J. Errico at New York university and Dr. James Zucherman at St. Mary’s Hospital in San Francisco.

Through a spokeswoman at New York University, Dr. Errico declined to comment. Dr. Zucherman says financial interests do not affect how he conducts research.

Ethics and Financial Gain

Few would argue that doctors should never be allowed to invest in promising new technologies. But when doctors are acting as researchers, they should not have money riding on the outcome, in the view of outside experts like Dr. Kevin A. Schulman, a professor of medicine and business at Duke University Medical Center who helps oversee clinical research there.

Duke, Dr. Schulman said, would generally not allow a doctor with a significant financial stake in a drug or device to be involved in a clinical study of it. An exception might be made for a surgeon who invented a new device and had special expertise in its use, Dr. Schulman said. But the Prodisc doctors appear to be simply investors.

In a statement, the Viscogliosi Brothers said, “We are proud of the fact that so many distinguished surgeons have invested in our funds and it validates their individual views on Prodisc as a highly effective technology.”

The F.D.A.’s rules allow clinical investigators to have financial ties with the maker of the device or drug they are studying — on the condition that such relationships are fully disclosed. Lawyers who have worked with the F.D.A. say that when it becomes aware of potential conflict, it tends to subject research to a higher level of scrutiny.

The F.D.A. now says it is checking to see whether there was adequate financial disclosure information about the Prodisc researchers during the clinical trial and at the time that the subsequent application for approval was submitted.

In early 2003, the Viscogliosi Brothers found a buyer for Spine Solutions. Synthes, a large Swiss medical manufacturer, agreed to pay $175 million at the deal’s closing and another $175 million if some of the company’s devices, including the Prodisc, got regulatory approval.

In a deposition, Dr. Balderston, who said he had invested about $500,000 with Viscogliosi Brothers, said the Synthes deal increased the value of his investment by “about 10 percent, 20 percent, something like that.”

Dr. Balderston was already an investor when he was recruited for the F.D.A. studies by Spine Solutions, according to his deposition. He failed to disclose those ties, according to the court records, which indicate that the clinical investigator form he filled out did not mention his investments.

Dr. Balderston said in the deposition he did not believe that he was required to disclose his holdings in the funds. “There were a lot of people who invested,” he said, “so my small number was not a significant number.”

Results of Prodisc Trials

In early 2005, when Synthes submitted the Prodisc study to the F.D.A. as part of the company’s application for approval, it used results for 162 patients who had received the device and 80 who had spinal fusion surgery.

The results did not include 50 Prodisc patients who were considered “training cases” — surgeries performed to let doctors learn how to implant the devices. Such training is fairly common in device trials.

An additional 21 patients, about 10 percent of those studied, were also excluded from the reported results.

A Medicare official, Dr. Steve Phurrough, said 10 percent was unusually high. While it is impossible to tell what the outcome of the study would have been otherwise, Dr. Phurrough said, “it gives us pause.” The agency decided last August not to cover the disk for most Medicare patients.

Hratch Vranian, a 52-year-old mechanical engineer from Pasadena, Calif., was one of the training cases in the Prodisc trial, and he is among those involved in the clinical trial who say that their surgeons were not able to offer much further help after the Prodisc did not relieve their pain.

Synthes says that in any clinical trial there are patients who do not complete the study. The company defends the quality of the Prodisc study. Because the F.D.A is rigorous about how a study is set up and conducted, said a Synthes spokesman, Gilgian Eisner, “it is not so easy to influence the F.D.A. trials.”

Many of the Prodisc researchers have moved on to other clinical trials.

Some include products made by other companies promoted by the Viscogliosi Brothers, like Paradigm Spine. Dr. Errico at New York University, for example, is a clinical investigator of a new spinal implant made by Paradigm Spine.

Close relationships between surgeons and device companies can affect more than the potential quality of an individual clinical trial, said Dr. Drummond Rennie, a professor of medicine at the University of California, San Francisco who has studied conflicts of interest among physicians. Because the entanglements are so common, Dr. Rennie said, it is unlikely another surgeon will speak out about any potential misgivings they have about any device.

“The absolute ideal from a drug or device company is everyone is covered,” he said. “And what they have it covered with is money.”

Banner Pharmacaps Receives FDA Approval For Nimodipine Softgel Capsules

Banner Pharmacaps Inc., a leader in the pharmaceutical industry for the development of soft gelatin dosage form technology, announced that the US Food & Drug Administration has granted approval for the Company's Abbreviated New Drug Application (ANDA) for Nimodipine 30 mg soft gelatin capsules.

Banner's Nimodipine 30 mg capsules are the AB-rated generic equivalent of Bayer's Nimotop® 30 mg capsules, and are indicated for the treatment of subarachnoid hemorrhage, a form of cerebral bleed. Banner's product can be dispensed either in blister packaging or in bottles.

Banner has partnered with Heritage Pharmaceuticals Inc., an Edison, New Jersey based generics company, for the exclusive US sales and marketing rights for Nimodipine.

About Banner Pharmacaps Inc.

Banner Pharmacaps Inc. is a global drug delivery and specialty pharmaceutical company which is developing a proprietary portfolio of unique products and oral dosage forms that include the enhanced technologies of enteric and controlled release softgels, as well as Soflet® Gelcaps. Headquartered in High Point, North Carolina, Banner is committed to the research, development, and manufacture of quality healthcare products to serve our global community.

Banner Pharmacaps Inc.

The parent company of Banner is VION N.V., an international food group that produces high-quality foodstuffs and ingredients for humans and animals. VION has annual sales of €7.4 Billion, with 15,150 employees worldwide. The head office of VION is in Son en Breugel, The Netherlands.

About Heritage Pharmaceuticals


Heritage Pharmaceuticals Inc. is an emerging generic pharmaceutical company engaged in the acquisition, licensing, development, marketing, sale and distribution of generic pharmaceutical products for the global prescription drug markets. Heritage launched its U.S. label in 2006 and currently markets 4 products over 15 SKU's. The Company will continue to introduce its acquired multi-source generic product line during 2008 following its tradition of premier quality, value and service in generics.

Features of purchase prescription medications on the Internet

Americans spent in 2006 more than 100 billions dollars on purchasing goods on the Internet. Because purchase online is convenient, easy, comfortable. It's nowadays possible to buy any prescription or generic drug, being at home or anywhere else where internet connection is available. There is no need to move out for a trip which can be difficult! All you have to do is — go to the online drug store, select and buy the prescription drug you need, after filling the mail order pharmacy. It's fast and easy! Here on the online drug store website, you do can consult the full description of each prescription pills and select the drug of your needs


More over, the online drug store is open 24 hours a day, means you do can order your medications at any convenient for you time.

If a prescription was already issued to you, you do can purchase at the online drug store recommended to you prescription medications or cheap generic drug, which are almost identical and bioequivalent in quality to branded pills. If you did not find time to visit a physician and are in emergency need of your medications, the online drug store's physician will consult you free of charges and select the best prescription drug or generic drug satisfying your needs

From which online drug store safely purchase prescription medications?

If you have never before purchase prescription drug from this online drug store, please take the time to pay attention to its design. How do its looks, what are your impressions? If an online drug store does not look well — do not purchase from it prescription medications.

Remember how long that drug store operative. Review the sections “Contacts” and/or “About us”. There you do must find detailed information about supplying medications. If instead of information about the company you find only the feed back form — do not trust such a store. Indicated phone number, fax, juridical address, testify that drug store is a reputable company. Before starting to purchase prescription medications, you do can call to the indicated phone number and make sure it's right.

If a generic is proposed to you?

If you ordered with the online drug store, for example generic viagra, do not be surprised to receive medications with a different name. Since generic are bioequivalent (made of the same active chemical elements) to branded pills, but just named differently. Popular and known drugs are manufactured by pharmaceutical companies-inventors, and generic are manufactured by other companies, after patent terms are out.

From a physician's point of view, generic drugs are better than branded prescription medications, for their chemical composition and way of taking are maximally well studied. Means generic drugs are more reliable and safe drugs. Accordingly, risks of eventual side effects are set up to the minimum for the manufacturer.

The FDA (Food and Drug Administration) controls the quality of all medications. Before allowing any manufacturer to start clinical tests generics or prescription medications must be registered at the FDA. More over pills can be on sale only they were approved. The methods of control used by the FDA are so strict that not more 1/5 of drugs are approved.

Who manufactures generic drugs?

Make sure to first know who manufactures the prescription medications, you intend to purchase. For example, if the generic viagra, proposed by the online drug store, is manufactured in India, means it is a quality and good generic. It is known that India — is the biggest and reliable manufacturer of generics. Large parts of generics are made in India. Among them we can name drugs for depression, prescription diet pills, sleeping pills, blood pressure medication, birth control pills, pain medication, slimming pills, asthma medication, impotence medication, stop smoking medication, arthritis medication and many other pills.

How much high quality prescription drugs and generics cost?

Be aware of purchasing too cheap prescription drugs. Keep in mind the fact that no one will sell regardless of the profits! That's why any reliable online drug store will never sell quality medication at the same prices it purchases pills from manufacturers. Thus more the online drug store, whose prices for drugs are closed to the prices proposed by other stores. If you find a site where prices are considerably lower than usual — do not hurry to purchase. More probably, you do will receive poor quality prescription medications and do will loose your money.

However show attention when purchasing generic and not branded pills! Thus manufacturing and advertising generics is substantially less expensive than doing the same with branded pills, that's why generics are always cheaper! A generic can cost 10, 20 or even 50 times lower than its equivalent branded drug. That's why prices for one generic must be compared only to the prices for another generic, and to the ones for branded pills. If you find on an online drug store generic at a quite lower price than on other stores — make the choice in favor of the usual, common price which justifies itself.

Discounts and actions for online drug store buyers

While purchasing a drug on the Internet, you do have obtain discount, you will not find on another drug store. Check out the drug store providing discounts ! Or the one offering many other advantages for it's customers, for example free shipping options for prescription medications and discount on further purchases. Such drug store deserves your attention. Indeed discounts will make you save some money even if pills are there a little costly than on other stores.

Shipping options for prescription pills

Pay attention to shipping options for prescription pills. For example on our site, you can choose between receiving prescription drugs by regular mail during 12-16 days or by EMS speed post during 5-9 days . Of course charges for express deliveries are little bit higher than for regular mail, but you can then faster received your prescription drugs.

Safety and privacy of prescription medication buyers

Extremely important to know that drug store does guarantee the privacy of your data. Make sure of that by going through the section “Privacy Policy”. On poor sites which do not care about their visitors and their privacy, everything can happen, up to the disclosure of confidential information. Means that anyone for example can easily get your credit card data and illegally use them. That is why you do must be very careful before disclosing your personal data when you intend to purchase prescription drugs. Disclose your personal information exclusively on safe pages where you can see the protocol https on the address line and not the protocol http! If you're invited to disclose your credit card data on a non secure page (page with the protocol http), please kindly refuse to purchase from that site.

Keeping in mind all our above stated advices, you probably do will make the choice of the right and reputable drug store able to satisfy your requirements

LONDON - A third of men with erectile dysfunction could not perform after taking their first tablet of an impotence drug and gave up sex entirely, acc

LONDON - A third of men with erectile dysfunction could not perform after taking their first tablet of an impotence drug and gave up sex entirely, according to a study presented at the European Society of Sexual Medicine on Tuesday.

The findings show the importance of the first-time pill for erectile dysfunction patients who could potentially see better results by switching tablets or increasing the dose, Dr. David Edwards, a general practitioner in Oxfordshire in England, and colleagues said.


Erectile dysfunction drugs like Pfizer Inc.'s Viagra, Eli Lilly and Co's Cialis and Bayer AG's Levitra work by increasing blood flow to the genitals.


The study presented at a conference in Lisbon and funded by Bayer looked at 631 men with an average age of 55 who had erectile dysfunction. All had at some point taken a pill for their condition, and 70 percent were still on some medication.

When the pills did not work the first time, 68 percent of men reported a loss of self-esteem, 32 percent felt depressed and 24 percent said they believed their condition could never be treated

One third simply did not return to their doctor to try an alternative treatment after a failed attempt, something the researchers said highlighted the fact many men delay or ignore treating their problem.

"These data confirm that men are still reluctant to seek help for their erectile dysfunction and highlight the importance of first-time success on improving aspects of well-being," the researchers wrote in an abstract.

FDA warns against Chinese-made supplements

WASHINGTON - Some Chinese-made dietary supplements marketed to provide male sexual enhancement contain undeclared erectile dysfunction drugs putting users at risk, the U.S. Food and Drug Administration warned Friday.

The agency advised consumers to stay away from Shangai Chaojimengnan supplements sold under the names Super Shangai, Strong Testis, Shangai Ultra, Shangai Ultra X, Lady Shangai and Shangai Regular. The Chinese-made supplements are packaged and distributed by Shangai Distributor Inc. of Puerto Rico.

Product testing indicated that some of the so-called supplements contain Viagra's active ingredient, sildenafil, or a compound with a chemical structure that mimics sildenafil.

The chemicals could interact with nitrates in drugs taken for disorders commonly associated with erectile dysfunction, including diabetes, high blood pressure, high cholesterol and heart disease. The result could dangerously lower a user's blood pressure, according to the FDA.

The agency also warned that the safety and purity of the illegal ingredients is unknown.

What is Cialis ?

Drug name: Cialis.
Generic Name: tadalafil
Active Ingredients: Tadalafil

Therapeutic actions: Tadalafil relaxes muscles within the penis. This allows increased blood flow into the penis, necessary to achieve and maintain an erection.

Indications: Tadalafil is used to treat erectile dysfunction (impotence).

Contraindications and cautions:

A small number of patients have lost eyesight in one eye after taking tadalafil. This type of vision loss is called non-arteritic anterior ischemic optic neuropathy (NAION). NAION causes a sudden loss of eyesight because blood flow is blocked to the optic nerve. It is not clear at this time if tadalafil causes NAION. NAION also happens in patients who do not take this medicine. People who have a higher chance for NAION include those who:

have heart disease;
are over 50 years old;
have diabetes;
have high blood pressure;
have high cholesterol;
smoke;
have certain eye problems

Stop using tadalafil if you have any loss in your eyesight and seek medical help right away.
Do not take tadalafil if you are taking any of the following medicines:
a nitrate such as nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro, others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), isosorbide mononitrate (Imdur, ISMO, Monoket), and others;
nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers");
an alpha blocker (other than tamsulosin (Flomax) 0.4 mg once a day) such as doxazosin (Cardura), guanadrel (Hylorel), prazosin (Minipress), terazosin (Hytrin), alfuzosin (Uroxatral), and others.
Taking tadalafil with any of these medications may cause very low blood pressure, possibly resulting in dizziness, fainting, stroke, or heart attack.
Contact your doctor or seek emergency medical attention for any erection that lasts longer than 4 hours. A sustained erection can damage the penis.
Refrain from further sexual activity and notify your doctor it you develop dizziness, nausea, or angina (pain, tightness, discomfort, numbness, or tingling in the chest, arms, neck, or jaw) during sexual activity.
Tadalafil is usually taken when needed before sexual activity. The effects of tadalafil may last for up to 36 hours or more. Your doctor will determine how often you can take tadalafil. Do not take tadalafil more often than is directed by your doctor.

Adverse effects: The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
If you experience any of the following serious side effects, stop taking tadalafil and seek emergency medical attention or contact your doctor immediately:
an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
chest pain or irregular heartbeats;
dizziness, nausea, or angina (pain, tightness, discomfort, numbness, or tingling in the chest, arms, neck, or jaw);
swelling of the ankles or legs;
shortness of breath;
prolonged or severe dizziness;
a prolonged (lasting longer than 4 hours) or painful erection.
Other, less serious side effects may be more likely to occur. Continue to take tadalafil and talk to your doctor if you experience
headache;
indigestion;
back pain;
muscle aches;
flushing;
stuffy or runny nose;
temporary blue tint in vision or difficulty telling the difference between the colors blue and green (uncommon).
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

Interactions:

Tadalafil should not be taken with excessive amounts of alcohol (e.g. 5 or more drinks). Excessive alcohol may increase the risk of headache, dizziness, increased heart rate, or low blood pressure when tadalafil is taken.
Grapefruit and grapefruit juice may interact with tadalafil. The interaction could lead to potentially adverse effects. You should discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
Do not take tadalafil if you are taking any of the following medicines:
a nitrate such as nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, Minitran, Deponit, Transderm-Nitro, others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), isosorbide mononitrate (Imdur, ISMO, Monoket), and others;
nitrates are also found in some recreational drugs such as amyl nitrate or nitrite ("poppers");
an alpha blocker (other than tamsulosin (Flomax) 0.4 mg once a day) such as doxazosin (Cardura), guanadrel (Hylorel), prazosin (Minipress), terazosin (Hytrin), alfuzosin (Uroxatral), and others.
Taking tadalafil with any of these medications may cause very low blood pressure, possibly resulting in dizziness, fainting, stroke, or heart attack.
Before taking tadalafil, tell your doctor if you are taking any of the following medications:
any other drug used to treat impotence, such as sildenafil (Viagra), vardenafil (Levitra), alprostadil (Caverject, Muse, Edex) or yohimbine (Yocon, Yodoxin, others);
the antibiotic erythromycin (E-Mycin, Eryc, Ery-Tab, others);
an antifungal medication such as itraconazole (Sporanox) or ketoconazole (Nizoral);
HIV medications such as indinavir (Crixivan), ritonavir (Norvir), and others.
You may not be able to take tadalafil, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
Drugs other than those listed here may also interact with tadalafil or affect your condition. Talk to your doctor or pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Additional Information: DO NOT SHARE THIS MEDICINE with others. DO NOT USE THIS MEDICINE for other health conditions. KEEP THIS PRODUCT, as well as syringes and needles, if needed during treatment, out of the reach of children. Do not reuse needles, syringes, or other materials.

Planning For A Future Influenza Pandemic

WHAT: In planning for a future influenza pandemic, most experts agree that two things are known for certain - there will be another pandemic someday, and nobody can predict when. In a commentary in the Journal of the American Medical Association, scientists at the National Institutes of Health discuss why predicting the next pandemic is so difficult and outline steps that can be taken to better understand the behavior of the virus. Drawing upon the lessons of past pandemics, the authors analyze the significance of the highly pathogenic avian influenza strain H5N1, which has spread among bird populations and infected hundreds of humans in the last decade. In preparing for the next influenza pandemic, however, the authors argue that researchers and public health officials should not focus solely on H5N1 strains, because the next pandemic might be caused by a different influenza virus. Instead, research efforts should go beyond H5N1 and focus broadly on influenza viruses. This entails improving our knowledge of the basic biological and ecological means by which influenza A viruses infect birds; enhancing surveillance of infected animals and the circulation of influenza virus globally; understanding how the virus evolves and jumps from birds and other animals to humans; finding new approaches to vaccine design and vaccination; and developing new antivirals and diagnostics. Such broad activities can also help combat seasonal influenza, which is a major public health concern in the United States, accounting for an estimated 36,000 deaths and 200,000 hospitalizations each year. ARTICLE: "The next influenza pandemic: can it be predicted?" by J Taubenberger, D Morens and A Fauci. JAMA DOI: 10.1001/jama.297.18.2025 (2007). SPOKESPERSONS: Anthony S. Fauci, M.D., NIAID director; Jeffery K. Taubenberger, M.D., Ph.D., senior investigator in the NIAID Laboratory of Infectious Diseases; and David M. Morens, M.D., a medical epidemiologist at NIAID. NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on basic immunology, transplantation and immune-related disorders, including autoimmune diseases, asthma and allergies. The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases.

Drinking Farm Milk Reduces Childhood Asthma And Allergies But Raw Consumption Remains Unsafe

Drinking farm milk can protect children against asthma and hayfever, according to a study of nearly 15,000 children published in the May issue of Clinical and Experimental Allergy. But consuming farm milk that hasn't been boiled poses serious health risks and further research is needed to develop a safe product that still provides good protection against these common childhood diseases. Researchers from Europe and the USA studied 14,893 children aged between five and 13 in Austria, Germany, the Netherlands, Sweden and Switzerland. The children were drawn from farm children, rural and suburban communities and Rudolph Steiner schools, which primarily cater for families with anthroposcopic lifestyles, who restrict their use of antibiotics, vaccinations, fever-reducing drugs and often follow a biodynamic diet. Parents were asked to complete detailed questionnaires about their child's consumption of milk, butter, yoghurt, eggs and fruit and vegetables and whether they were farm-produced or shop-bought. They also answered questions about their child's height and weight, whether they were breastfed and any allergies or asthma problems affecting the child or their family. Allergy- related blood tests were also carried out on just under 4,000 children from across the five countries and the questionnaire results were validated with random telephone interviews with 493 respondents The researchers discovered that children who drank farm milk were much less likely to suffer from hayfever and asthma. Lower levels of diagnosed asthma were also observed for all farm-produced dairy products and eating farm eggs also provided protection against hayfever. However, these foods only provided increased protection when the children also drank unpasteurised farm milk - not in isolation. None of the farm products had any effect on eczema levels. "All the children drinking unpasteurised farm milk and eating other farm-related dairy products showed the same level of protection against asthma and allergies, regardless of whether they were living on a farm or not" says lead author Marco Waser, a doctor in natural sciences from the Institute of Social and Preventative Medicine at the University of Basel, Switzerland. "This is an important finding as it rules out other protective factors that farm life may provide, such as exposure to microbial compounds in animal shed and farm homes. For example, earlier studies have shown that farm children are less likely to be affected by pollen. "Our research showed that the children who enjoyed the best protection from asthma and allergies had been drinking farm milk since their first year of life." About half of the parents who told researchers that their child regularly drank farm milk said that they did not boil the milk before giving it to them. The protective results were the same, regardless of whether milk was boiled or not. However, as drinking raw milk is not recommended, especially for young children, this may have encouraged parents to say they boiled milk when they didn't, indicating a higher level of raw milk consumption. "The results of this study indicate that all children drinking farm milk have a lower chance of developing asthma and hayfever" says Dr Waser. "However raw milk may contain pathogens such as salmonella or enterohaemorrhagic E coli and its consumption may have serious health risks. "We need to develop a deeper understanding of why farm milk offers children this higher level or protection and investigate ways of making the product safer, while retaining these protective qualities. "At the moment we can only speculate about why farm milk protects children against asthma and allergies. Perhaps it is because farm milk has different levels or compositions of pathogenic and non-pathogenic microbes to milk sold in shops. "It is interesting that there was no difference in the farm milk results regardless of whether it was boiled before consumption. As boiling is likely to have been over-reported, this could indicate that pasteurisation is not as important as previously thought, as compounds other than microbes may offer a protective role. "But despite our findings, we cannot recommend consumption of raw farm milk as a preventative measure against asthma and allergies." More than 35 researchers took part in the PARSIFAL study - Prevention of Allergy risk factors for sensitisation in children related to farming and anthroposophic lifestyle. The work was carried out with research grants from the European Union, the Swiss National Research Foundation, the Swiss-based Kuehne-Foundation and the Swedish Foundation for Health Care Science and Allergy Research. • Inverse association of farm milk consumption with asthma and Allergy in rural and suburban populations across Europe. Waser et al. Clinical and Experimental Allergy. 37, 661-670. • Aimed at Allergy practitioners and research scientists with an interest in allergic diseases and mechanisms, Clinical and Experimental Allergy (

What Is a Nuclear Heart Scan?

A nuclear heart scan is a type of medical test that allows your doctor to get important information about the health of your heart. During a nuclear heart scan, a safe, radioactive material called a tracer is injected through a vein into your bloodstream. The tracer then travels to your heart. The tracer releases energy, which special cameras outside of your body detect. The cameras use the energy to create pictures of different parts of your heart.
Nuclear heart scans are used for three main purposes:
To provide information about the flow of blood throughout the heart muscle. If the scan shows that one part of the heart muscle isn’t receiving blood, it’s a sign of a possible narrowing or blockage in the coronary arteries (the arteries that supply blood and oxygen to your heart). Decreased blood flow through the coronary arteries may mean you have coronary artery disease (CAD). CAD can lead to angina, heart attack, and other heart problems. When a nuclear heart scan is performed for this purpose, it’s called myocardial perfusion scanning.
To look for damaged heart muscle. Damage may be due to a previous heart attack, injury, infection, or medicine. When a nuclear heart scan is performed for this purpose, it’s called myocardial viability testing.
To see how well your heart pumps blood out to your body. When a nuclear heart scan is performed for this purpose, it’s called ventricular function scanning.
Usually, two sets of pictures are taken during a nuclear heart scan. The first set is taken when the heart is beating fast due to you exercising. This is called a cardiac stress test. If you can’t exercise, your heart rate can be increased using medicines such as adenosine, dipyridamole, or dobutamine.
The second set of pictures is taken later, when the heart is at rest and beating at a normal rate.

What Is Cardiac Catheterization?

Cardiac catheterization (KATH-e-ter-i-ZA-shun) is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. Through the catheter, doctors can perform diagnostic tests and treatments on your heart.
Sometimes a special dye is put into the catheter to make the insides of your heart and blood vessels show up on x rays. The dye can show whether a material called plaque (plak) has narrowed or blocked any of your heart’s arteries (called coronary arteries).
Plaque is made up of fat, cholesterol, calcium, and other substances found in your blood. The buildup of plaque narrows the inside of the arteries and, in time, may restrict blood flow to your heart. When this happens, it’s called coronary artery disease (CAD).
Blockages in the arteries also can be seen using ultrasound during cardiac catheterization. Ultrasound uses sound waves to create detailed pictures of the heart’s blood vessels.
Doctors may take samples of blood and heart muscle during cardiac catheterization, as well as do minor heart surgery.
Cardiologists (doctors who specialize in treating people who have heart problems) usually perform cardiac catheterization in a hospital. You’re awake during the procedure, and it causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter. Cardiac catheterization rarely causes serious complications.

vitamin information

As active weight lifters, what role do vitamins play in improving our performance? We know there important but what do vitamins actually do?

I'd like to breifly provide some vitamin information about the role that vitamins and minerals play in the muscle building process.


First of all, Vitamins are necessary for growth, health, and metabolism. Vitamins perform highly specific metabolic functions, especially in energy metabolism and are vital to all our biological functions including the synthesis of muscle tissue. Which is of course, what we all want!

Here's some important vitamin information, vitamins do not actually provide energy to the body or build muscle.

What's that you say? If vitamins don't build muscle than what do they do? Vitamins actually help release energy provided by the macro nutrients such as fat, protein, and carbohydrates.

Hard workouts increase your nutritional needs. There’s no doubt about it. You must ensure that you are getting the optimal amount of vitamins in your diet.

That’s why you may want to add certain vitamins to your nutritional game plan for building muscle. Keep in mind that vitamin supplements should not replace food. Your body can get almost all the nutrients it requires from a balanced diet.

Your body absorbs nutrients best from food. However, you might want to think of adding a vitamin supplement as good insurance. Adding a daily multi vitamin and antioxidant containing 100% of the daily values may be a good move. I like to think of it as covering my nutritional bases

Certain vitamins belong to a group known as antioxidants which fight off disease causing chemicals known as free radicals. Very important.

Here is a partial list of some important vitamins and their functions:

Vitamin information- Vitamin A

Function:

Vitamin A helps to maintain the skin, bone and tooth growth

Sources:


Vitamin A is plentiful in vegetables such as carrots, beans, yams, and spinach. Also found in liver, egg yolks, and whole milk.

Notes:

Vitamin comes in two forms, carotene and retinol.

Vitamin information- Vitamin B1 (Thiamine)

Function:

Vitamin B1 plays a very important part of the energy conversion process. Vitamin B1 helps your body in breaking down carbohydrates to energy. Necessary for the maintenance of a healthy nervous system, growth, and muscle tone

Sources:

Bran flakes, wheat germ, whole grains, pork, liver and dried beans.

Notes:

Refined foods often depletes Vitamin B1 from carbohydrates.

Vitamin information- Vitamin B2 (Riboflavin)

Function:

Vitamin B2 helps your body in releasing energy from protein, carbohydrates, and fats. Vitamin B2 also helps in the maintenance and growth of tissues.

Sources:

Eggs, milk, liver, eggs, whole grain breads, cereals, meats and legumes.

Notes:

An important part of energy metabolism and supports skin care and vision.

Vitamin information- Vitamin B3 (Niacin)

Function:

Vitamin B3 is used in energy metabolism and supports skin care. Vitamin B3 also helps to support the nervous system and digestive system.

Sources:

Tuna, chicken, liver, breads, cereals and legumes.


Vitamin information- Vitamin B5 (Pantothenic acid)
Function:
Helps transform amino acids and fats into glucose. Fatty acid oxidation
Sources:
Found in a lot of whole foods.
Vitamin information- Vitamin B6 (Pyridoxine)
Function:
Vitamin B6 helps in the conversion of stored liver and muscle glycogen into energy. Also helps in protein metabolism.
Sources:
Liver, bananas, fish, whole grains, nuts, vegetables, meat and chicken.
Notes:
Used in amino acid and fatty acid metabolism.
Vitamin information- Vitamin B9 (Folic acid)
Function:
Regulation of growth. Helps breakdown protein. Also necessary for normal production of red and white blood cells.
Sources:
Liver and leafy green vegetables.
Vitamin information- Vitamin B12
Function:
Vitamin B12 helps in the production of red blood cells. Also helps metabolize carbohydrates, protein, and fat.
Sources:
White fish, cheese, lean meat, liver, chicken, eggs, and dairy products.
Notes:
Daily requirements are usually low since the liver stores large amounts of Vitamin B12
Vitamin information- Vitamin C
Function:
Vitamin C helps in the absorption of iron and in the production of collagen. Helps maintain normal connective tissues. May help protect against exercise induced tissue damage.
Sources:
Citrus fruits and juices, oranges, green peppers, cabbage, potatoes, broccoli and tomatoes.
Notes:
Vitamin C is an antioxidant and may be help to decrease tissue damage caused by heavy exercise
Vitamin information- Vitamin D
Function:
Vitamin D assists in maintaining strong bones and teeth
Sources:
Cod liver oil, liver, egg yolks, sunlight (your skin converts sunlight to vitamin D).
Notes:
Vitamin D can be toxic if taken in excess. An excess of vitamin D can cause calcium deposits in soft tissues such as the kidneys, arteries and joints.
Vitamin information- Vitamin E
Function:
Vitamin E helps to prevent the destruction of red blood cells. Vitamin E also helps to improve blood flow by helping to maintain a healthy cardiovascular system.
Sources:
Green vegetables, raw seeds, vegetable oils, nuts, wheat germ, eggs, and whole grains
Notes:
Vitamin E is an antioxidant and may be help to decrease tissue damage caused by heavy exercise
Vitamin information- Vitamin H (Biotin)
Function:
Helps in the breakdown of fats
Sources:
Egg yolks and liver
Vitamin information- Vitamin K
Function:
Vitamin K helps control blot clot rate. Involved in glycogen formation and bone formation.
Sources:
Brussel sprouts, broccoli, leafy vegetables, tomatoes, cauliflower, milk, and yogurt.
Vitamin information
Minerals
Apart from vitamins, minerals are also required for growth, maintenance and repair of the body. They help supply oxygen to cells, improve digestion, and help keep the body in balance. Minerals also participate in the proper functioning of the muscular and nervous systems.
The tissues in your body contain fluids on the inside of cells and in the spaces between cells. In these fluids are electrolytes. Electrolytes are electrically charged minerals or ions.
The electrolytes help regulate water balance on either side of the cell membranes and also help make muscles contract.
The two main electrolytes are sodium and potassium. Potassium helps regulate fluids on the inside of cells while sodium helps regulate fluids on the outside of cells.
For optimum functioning, electrolytes must be kept in balance.
Here is a partial list of minerals and there functions
Vitamin information- Sodium
Function:
Maintenance of fluid balance on either side of cell walls. Also helps in muscular contractions and nerve transmissions
Source:
Found in most foods
Vitamin information- Potassium
Function:
Maintenance of fluid balance on either side of cell walls. Assists in the conversion of glucose to glycogen. Helps in muscular contractions and never transmissions.
Source:
Fruits and vegetables, bananas, and potatoes

Vitamin information- Calcium
Function:
Essential for blood clotting, muscle contractions, and nerve transmissions. Also helps with bone and teeth formation
Sources:
Green leafy vegetables and dairy products.
Vitamin information- Chlorine
Function:
Helps maintain water balance by regulating pressure.
Source:
Kelp, table salt
Vitamin information- Magnesium
Function:
Helps in neuromuscular contractions. Also helps the metabolism of carbohydrates and proteins.
Source:
Whole grains, green vegetables, and legumes
Vitamin information- Phosphorus
Function:
Helps stimulate muscular contractions. Helps metabolize carbohydrates, fat, and protein. Also assists in energy production.
Sources:
Chicken, fish, Meats, whole grains, and nuts.
Vitamin information
Antioxidants
Anti what? Antioxidants have been getting a lot of attention lately in the sports industry. Antioxidants, mainly beta carotene, vitamin C, vitamin E, and the minerals selenium, zinc, copper, and manganese have been generating a lot of excitement regarding their disease fighting properties.
Antioxidants help fight free radicals or rather chemicals naturally produced by the body that cause irreversible damage to cells. Free radicals can leave your body open to such diseases as cancer, advanced aging, degenerative diseases, and cardiovascular diseases.
What causes free radicals? Nobody knows for sure but certain environmental factors such as cigarette smoke, radiation, exhaust fumes, certain drugs, stress and too much sunlight contribute to the increase in free radicals.
Oddly enough, steady exercise and weight lifting seems to increase the amount of free radicals in the body. No one really knows why exercise increases free radicals in the body but it is important to understand that there are ways to combat free radicals.
It is important to build up your immune systems while weight training and getting enough antioxidants is one way to do it.
Vitamin information- Vitamin C
When you get a cold, what’s the first supplement you reach for? I’m guessing it’s vitamin C. Vitamin C is an essential part of our diets and operates in the formation of connective tissues. Vitamin C is also involved in immunity, allergic responses and wound healing.
As an anti oxidant, vitamin C also helps keep free radicals from destroying the outer cells. As a weight trainer, a cold or infection can side line you pretty quick. Vitamin C can help cut the risk of respiratory infections and boost immunity.
The best sources of vitamin C come from citrus fruits and juices, green peppers, kiwi, cantaloupe and green leafy vegetables.
Vitamin information- Vitamin E
As an antioxidant, vitamin E has been shown to protect against after workout muscle damage and the free radical production that follows.
Part of vitamin E’s job is to scavenge free radicals produced by weight lifting therefore saving tissue from damage. Vitamin E also seems to prevent the destruction of oxygen carrying red blood cells which means improved oxygen delivery to your muscles during exercise.
The best sources of vitamin E come from wheat germ, seeds, nuts, fish oils, and vegetable oils.
Vitamin information- Beta Carotene
Once beta carotene is ingested by the body, it is converted to vitamin A as the body needs it. Beta carotene destroys free radicals after they’ve formed and may help reduce muscle soreness after weight lifting.
The best sources of beta carotene comes from carrots, sweet potatoes, broccoli, spinach, and cantaloupe.
It is important to note that vitamins and minerals do not directly build muscle or supply energy. Vitamins and minerals have very precise functions that help synthesis muscle tissue and in the metabolism of energy.
Supplementing with a vitamin and minerals will not boost the body’s muscle building abilities but rather enure that you have the optimal amounts to enhance the bodies ability to help synthesis muscle tissue and metabolize energy.
Think of supplementing with a quality vitamin/mineral supplement as covering your nutritional bases.

Canadian Cancer Society Announces Vitamin D Recommendation

The Canadian Cancer Society is recommending a specific amount of Vitamins D supplementation for Canadians to consider taking. This first-time recommendation is based on the growing body of evidence about the link between Vitamins D and reducing risk for colorectal, breast and prostate cancers. "The evidence is still growing in this area, but we want to give guidance to Canadians about this emerging area of cancer prevention based on what we know now," says Heather Logan, Director, Cancer Control Policy, Canadian Cancer Society. "As we find out more we will update our recommendation." In consultation with their healthcare provider, the Society is recommending that: -- Adults living in Canada should consider taking Vitamins D supplementation of 1,000 international units (IU) a day during the fall and winter. -- Adults at higher risk of having lower Vitamins D levels should consider taking Vitamins D supplementation of 1,000 IU/day all year round. This includes people: - who are older; - with dark skin; - who don't go outside often, and - who wear clothing that covers most of their skin. "We're recommending 1,000 IUs daily because the current evidence suggests this amount will help reduce cancer risk with the least potential for harm," says Logan. "More research is needed to clearly define the amount of Vitamins D that will maximize health benefits." Logan explains that Canada's geographic location was a strong factor in the Society's decision making about the recommendation. "Where a person lives is one important factor in how much Vitamins D they can produce from the sun. Because of our country's northern latitude, the sun's rays are weaker in the fall and winter and Canadians don't produce enough Vitamins D from sunlight during this time." Research findings announced today add to the mounting evidence in this area. A study published in The American Journal of Clinical Nutrition found that taking Vitamins D supplements and calcium substantially reduces all-cancer risk in post menopausal women. Specifically, the researchers found that the higher the levels of Vitamins D in the blood, the lower the relative risk of developing cancer. As well, another study released in May, suggests that women who consume more calcium and Vitamins D may be less likely to develop breast cancer before menopause. In addition to taking supplements, people can get Vitamins D by exposure to the sunlight and in their diets. However, Logan cautions Canadians about relying too much on getting Vitamins D through exposure to sunlight. "It's important to remember that a few minutes a day of unprotected sun exposure is usually all that is needed for some people to get enough Vitamins D," says Logan. "It's not a good idea to rely solely on the sun to obtain Vitamins D. For some people, it's possible that just a few minutes of unprotected sun exposure every day could increase skin cancer risk." Logan says a large-scale clinical trial would help provide more answers about the amount of Vitamins D needed to maximize health benefits, and the long-term risks, if any, of taking large doses of the vitamin. "The Canadian Cancer Society is looking seriously at what we can do to make this research happen. We will also be talking to our partners about this. We need to keep building on our knowledge about this important area of cancer prevention." More research is also needed about the amount of sunlight exposure needed to achieve the optimum Vitamins D level. The Society is not changing its SunSense guidelines, as skin cancer is the most frequently diagnosed cancer in Canada. The Society recommends that people reduce their exposure to the sun, particularly between 11 a.m. and 4 p.m. when the sun's rays are the strongest. Use a sunscreen with a sun protection factor (SPF) 15 or higher and SPF 30 if you work outdoors or if you will be outside for most of the day. At this time, the Canadian Cancer Society does not have a recommendation for Vitamins D supplementation for children. The research to date about the role of Vitamins D and cancer prevention has focused on adults. The Canadian Dermatology Association recently updated its recommendations about Vitamins D supplementation. The association's website says: "In order to lessen the health risks associated with skin cancer yet still reap the known and possible benefits of Vitamins D levels take 1,000 international units of Vitamins D supplements a day." The Canadian Cancer Society is a national community-based organization of volunteers whose mission is to eradicate cancer and to enhance the quality of life of people living with cancer.

Statistics of the prices generic

Abstract:
Background: Because of the scarcity of health care resources, governments have large incentives to contain high pharmaceutical expenditure growth rates. Thus, in order to influence pharmaceutical costs, governments must understand the determinants (both economic and regulatory) of competition between pharmaceutical firms, which in turn determines prices and demand for pharmaceuticals.

Researchers often study off-patent drugs because of payors' expectations that once a drug loses patent, competition should ensue and costs should decline. Most studies have focused on competition between pioneers (branded off-patent drugs) and their generic equivalents because often pioneers' prices and market shares remain high after patent expiration. Few studies have modelled the determinants of competition in the generic vs. generic sphere. Moreover, preliminary evidence shows that generic prices are often not as low as expected, and that the lowest price generics often do not achieve the largest market shares.

Aim: Increased price competition amongst generics could offer health systems new opportunity for pharmaceutical savings. Therefore, this study will model determinants of price competition amongst generics to offer a newfound understanding of ways in which pharmaceutical expenditures could be contained more efficiently.

Methodology: This study conducted panel data, multivariate analysis to determine the effect that determinants of competition (market concentration, number of presentations sold, time since generic entry, etc.) have on generic prices.

This study used data from Intercontinental Medical Statistics (IMS) Health. Price and sales data is presented by drug molecule name, country, strength, package size, formulation, company name and generic/brand status. This paper studied omeprazole (a PPI) and paroxetine (a SSRI), both of which treat chronic conditions, are primarily sold through retail/outpatient pharmacies, are primarily sold in tablet/capsule form, and which have large markets that are conducive to significant sample sizes. In addition, both molecules went off patent in most countries during the study period, 2000-2005.

For comparative purposes, this study includes countries that represent different approaches to pharmaceutical regulation: 1) US—free market approach, 2) UK—regulatory approach with free market incentive, 3) Germany—free market and reference pricing, and 4) France—price controls/negotiation and reference pricing.

Findings: This study rejected the null hypothesis of perfect competition. The predicted effect of generic competition—low generic prices—is crowded out by product differentiation and reimbursement schemes. Moreover, the demand side often does not succeed in purchasing the lowest price generics.

Price by Cialis

My supervision of the prices on the online
From $1.61
Up to $2.11

Price by Generic Viagra

My supervision of the prices on the online
From $1.27
Up to $1.60