Once you put money behind pride, the push is on to make sure you have the edge. If your natural abilities are not enough, the temptation is to “cheat”. Ah, a wonderful word! What’s cheating? The easy answer — it’s getting an unfair advantage. So, if you know your opponent likes to play fast, you play slow. You shout and scream abuse to intimidate him or her. If you need big muscles, you do steroids (like everyone else). The folks who draw up the rules have to keep the sport as fair as possible without killing spectator interest. The fans must want to pay to see it played. If you stop the players from being too creative, the paying fans may lose interest and the ticket money will dry up. That would never do.

On the doping front, the responsibility fall to the World Anti-Doping Agency (WADA). It decides what’s fair on the basis of scientific evidence. Except, of course, that what’s “fair” one year, may be considered unfair the next. Fashions and sporting cultures change. The latest hot potato is unusual. We all know how effective viagra can be in the sack. But it seems top sportsmen have been using it to increase their competitive edge. Since it dilates blood vessels, it can improve the flow of oxygenated blood around the body and increase endurance, especially when the player is competing above sea level. WADA has commissioned two research projects. One is looking at whether it gives an unfair advantage where cyclists, distance runners or players need good aerobic performance but there is air pollution or altitude is a factor. The other is looking at its use in training. If the results suggest unfair advantage, viagra could be banned in September 2009.

So two final thoughts. The first is that the research is difficult because none of the players will take this drug on its own. It will be one of a cocktail to enhance performance. The two research groups are testing viagra on its own. This makes the results difficult to relate to the question of whether players do get an edge. The second is that if professionals are getting a boost, you too could find your prowess improved in every kind of way if you use viagra. If you want endurance in sex (whether at altitude or not), this is the way to get it.

Ah, this mysterious thing called love. According to the guys who write pop songs, there ain’t no sunshine when she’s gone and you always have her on your mind. Suddenly, there’s supposed to be a whole new meaning to the repeated act. Now it’s an affirmation of your continuing love and affection. Except that you’re not always in the mood at the same time and what was exciting at first grows less so. What should a couple do when there’s less sex? Should this be considered a medical problem? Everything is probably working as it should. It’s just there’s less interest. This thing called libido is replaced by a growing loneliness as the two that were one become two again.

Of course, a man is supposed to be driven by the desire to have hot, passionate sex every night. The myths of frequency and enjoyment cling tightly to us. If there are problems, they can so easily be fixed by taking the little blue pill. Even if we failed to get an erection for the last two or three nights, viagra can fix everything. Except it can’t. Viagra only works to produce an erection when we are sexually stimulated. If, for some reason, we stop finding sex so interesting, no pill in the world is going to save us from our own lack of desire. Then perhaps we discover that we remain in love with our partners but not in love with sex. Alternatively, we find the relationship is at an end and go find a new interest in sex with a new partner.

Almost without exception, the medicine approval and regulatory bodies only look at medications. If something is packaged as a natural or herbal product, there is no need to go through the local regulatory procedures. Anyone can put such products on to the market and, depending on the local controls on advertising, make whatever claims will impress the gullible. Let’s just pause for a moment. That means there are no clinical trials to prove that these products are safe or, indeed, that they have any effect. Worse, mass advertising often makes outrageous claims without any real penalty. So, it takes something fairly spectacular to provoke a government into taking action.

The Canadian authorities have just issued a warning to local consumers not to use two local products alleged to enhance male sexual performance. So far, nothing exceptional. Except that these products did actually have an effect. The reason? The manufacturers added a little viagra to the mix. Now the irony of the Canadian authority’s intervention is complete. Having approved viagra as a medication for distribution in Canada, the same authority orders the withdrawal of a product because it contains viagra. To use the more formal language of the regulators, these products contained an undisclosed pharmaceutical ingredient that should only be made available on prescription and under the supervision of a physician. Putting a human face on this, suppose that Joe, one of those men with problems in his plumbing, also has problems with blood pressure or has recently had a heart attack, adding any amount of the little blue pill into the mixture could have dangerous results. The whole point of consulting a physician before taking any drug is to reduce the risk there will be adverse side-effects.

On many levels, the sale of these products gives cause for concern. The first and most obvious is the failure to warn the public that an “all natural” product was actually a pharmaceutical product in disguise. Then we have issues with the labels that contained incomplete information about the “ingredients”. However, it is relatively unusual for a “manufacturer” to include viagra in its pills to ensure that they did actually work. If nothing else, it shows a remarkable degree of trust in viagra to deliver the promised enhancements.

As a routine, men should be encouraged to monitor their waist measurements as a simple means of judging when the risks are rising. Anything over 37 inches for men (and 31.5 inches for women) is in the danger zone and suggests the need to check blood pressure. Once a person is at risk, there should be positive intervention to counsel lifestyle changes, starting with quitting smoking and eating a more healthy diet to reduce the cholesterol levels. However, there is a significant link between cardiovascular disease and erectile dysfunction (ED). It may be a side-effect of the drugs to control the cardiovascular problems, damage to the arterial system or nerve endings, or it may be linked to the depression many experience. The interaction between these factors can produce a vicious cycle. As the ED worsens, depression deepens justifying more powerful drugs that further affect sexual performance.

All men at risk should be asked a direct question, “Are you suffering from ED?” If the answer is, “Yes.” this should trigger a review of the drugs being taken, and the prescription of viagra to begin restoring sexual activity. However, to be effective, men must be convinced that ED is a symptom of cardiovascular disease and be prepared to answer the question honestly. Too many consider such a question to invade their privacy, and either lie or refuse to answer. In its own right, this process is difficult because those who live in poverty and in deprived areas are often not contacted as easily and are reluctant to come into clinics for any type of treatment. It may be necessary for local health providers to physically go into the community to provide health screening and health assessments. This is preventative medicine as it should be practised. The earlier ED is identified as a predictive symptom of cardiovascular disease, the more men may be saved the trauma of a stroke or heart attack. This will require a diversion of funding to community-based medicine and to state funding of medications such as viagra to help treat the ED. But it should save money in the long term.

For both men and women, there are hormones and biological drives which guide physical growth and give us an interest in reproduction. Because of the physical gender differences, boys and girls are nurtured to have different functional expectations. Being a man means fertilizing the eggs. Being a woman means having the resulting babies. In later life, should something happen to interfere with reproductive abilities, those affected can at least look back on some life where pleasure and function worked together. But it is emotionally difficult when nature or an accident denies you the chance to experience sexual activity. Although those affected never know what they have missed, there is an underlying sadness and frustration.

For teenage boys, erectile dysfunction (ED) is not a common problem. As a result, there is little research. Most healthcare providers prefer a simplistic and dismissive diagnosis of psychological dysfunction and, where there is medical insurance to cover it, refer those affected for counseling. Such research as there is actually prefers formal assessment of the vascular system. A recent meta-research study examined research carried out between 1998 and 2003, looking for common factors in diagnosis and treatments for teenagers under the age of 19 years. On average the young men had suffered symptoms of ED for an average of two years with the most common causes being perineal and penile trauma, and surgery. Formal vascular examinations were carried out in 60% of all cases and almost half were found to have serious problems justifying further angiographic study or surgery.

In other words, half the teenagers given a formal test were found to have abnormal blood flow as the explanation for their ED. The practice of routine referral for counseling is expensive and ineffective because, in most cases, the usual consequence of recommending viagra will not represent the best treatment. Indeed, because of the expense, most healthcare providers simply write out a prescription for viagra and send the patients away with the reassurance that they will grow out of it, or everything will work out fine when they meet the right woman. At the very least, there should be a detailed survey of medical history to see whether there is evidence of traumatic injury as the trigger for haemodynamic testing. Our young always deserve the best treatment.

So, in the spirit of truthfulness and honesty for which I am justly famous, I’m going to give you the inside story behind the plot to wipe out the Hells Angels. As you probably know, Federal Government considers this to be a criminal organization specializing in drug dealing, extortion, trafficking in stolen goods, etc. But there’s a real problem for the FBI and other law enforcement agencies. These guys are continuously on the move. It’s not as if you can set up surveillance, tap into telephone lines and do all the stuff you see in TV programs and movies. Trying to get undercover officers inside the organization has also proved difficult. The Feds therefore hit on the obvious solution. If you can’t collect evidence to put them all in jail, you wipe them out.

Most of the Angles ride Harley-Davidsons. This is their weakness. Undercover officers have infiltrated the manufacturing facilities and have modified all motorcycles to produce impotence. This plot has only recently been uncovered. It’s one of those unfortunate accidents of fate. Japanese scientists have been researching the higher rates of erectile dysfunction among motorcycle users and they discovered that the engines of cycles made in the US have been modified to produce vibrations at the frequency range most likely to cause nerve damage. Even more insidiously, these vibrations affect the production of hormones needed to ensure the prostate and bladders remain healthy. There’s also evidence that seat design has been adjusted so there’s pressure on the perineum to reduce the flow of blood through the artery into the penis. Around 75% of riders between 40 and 49 years, and 93% of those who are 50 years and older reported severe erectile dysfunction. Naturally, there’s been a significant increase in the use of viagra among Hells Angels as they fight to keep the juices flowing. Wikileaks has documents from the FBI showing its efforts to intercept supplies of viagra ordered online. The battle is ongoing. Watch this space for more disclosures.

Taken by surprise, I find myself agreeing with Natasha Bedingfield. To be honest, I had to google her. Yes, I am that disconnected from the real world. It seems she has produced two albums, the last one featuring the encouraging, “I Wanna Have Your Babies”. Anyway, this young lady of 26 summers has just found Mr. Right and demonstrates she has a wry sense of humor. It seems her fiancé is hotter than David Beckham! I’m sure Victoria is relieved to hear that although quite how she knows how hot the older David can be is anyone’s guess.

But it was the headline that caught my eye. “Romance is female viagra.” So there you have it. Whereas we poor men have to keep popping the little blue pills, all women need to get in the mood is a bunch of flowers and a box of chocolates. Well, that’s young love for you. In the interview, she’s proud of the fact that they write each other little love letters. It seems they still talk to each other. He’s charming and funny. I think I did that once. Well, I can do charming and, if in the mood, funny. But both at the same time is a real challenge. But her intended seems able to sweet talk entertainingly. Ah, the things you can do when you’re young and in love. Except there’s a lesson there for us older men as well. It’s too easy to get wrapped up in the selfish point of view. I’m having troubles so all I need to do is order some viagra online and then I’ll be alright. Where’s the mention of my partner in all this.

Relationships have two partners. It’s no good one getting in the mood with artificial aids if the other is experiencing one of her headaches. Natasha is right that both should be working towards the same end. We men should therefore take the time to remember the days of romance. It starts with talking to your partner, sharing the problems and asking for help. When she turns out to be on your side, you need to say thank you with a present. Yes, it’s only a token and she should know you still love her, but it never hurts to produce evidence every now and again. Then when the romance is doing its viagra act for her, you can take one of the little blue pills and enjoy the results.

Well, there’s this old saying: the proof of the pudding is in the eating. In the drug industry, once FDA approval is given, all the patients get to eat the drug to find out whether it proves good. It turns the market into a giant laboratory where all the patients are lab rats. Most of the time, it all works well. But, occasionally, patients die.

The other feature of this process is the contribution of the lawyers. These happy people run around protecting Big Pharma’s intellectual property rights in the drugs. They want you to be safe. If anyone else comes along with a copy or, worse, a fake, they fall from the sky like avenging angels and strike the beasts down. So it is with great joy and rejoicing that we can report Pfizer is in the case yet again. This time their target is “Styriagra”. This is a delicate, glazed candy treat — pumpkin seeds coated in chocolate. Now here’s the inside story. Deep in Austria lurks this “terrible criminal”. He’s one of many who run businesses in Styria making oil from pumpkin seeds. In fact, the province has something of a reputation for this oil. This Austrian has experimented and produced this candy. For reasons all to easy to imagine, he made his tiny chocolate treats “oval” in shape, but not blue in color. Pfizer is convinced this candy is intended to trade on viagra’s name and reputation. Apparently little blue diamonds are exactly like chocolate ovals.

Now here’s the test. If you go online to buy viagra, will you be confused if you see adverts for “Stryiagra” that notorious Austrian pumpkin treat? Might your focus waiver? Might you suddenly doubt the last ten years of history and buy pumpkin seeds to cure your erectile dysfunction? Well, I don’t think so, but Pfizer’s lawyers are on the case. I know I will sleep more soundly in my bed tonight. Thank you Pfizer for keeping us safe.

All of which brings me to a case that’s making headlines on the inside pages of newspapers in Brooklyn. We’re interested in the activities of Elvis Elano. The Christian name gives away his age with his birth coming at the height of the King’s fame. Anyway, this forty-something man has been carrying on an affair with a fifty-something woman. He was determined to ensure his performance was never less than perfect so he relied on the little blue bill. There was just one problem. He could not afford to have suspicious plain brown packages arriving at his home address. So his mistress was more than happy to co-operate, allowing him to use her address for delivery purposes.

So far, this all looks like a routine case of adultery except that there’s one small fact omitted from the description that converts this into a rather different situation. Elvis is not married. He’s a sexually experienced man who routinely bought his viagra online, knowing that he sometimes had problems. But the nature and extent of Elvis’ problems have grown in dramatic ways. He’s a Catholic priest, now suspended from his work in the diocese and the Catholic hospital where he also acts as a counselor and confessor. He’s accused of being predatory. The woman was going through a divorce and was looking for spiritual guidance from the priest. It’s alleged he said their meeting was not an accident, that a relationship with him had been ordained by God. This potentially coercive seduction technique found a willing party and, for seven months, the viagra worked its magic. Now, the knives are out and multi-million dollars of damages are being claimed from the priest and the diocese for failing to supervise him.

All of which brings us back to the point that, if he had been forced to go to his own physician to get a prescription for the viagra, questions would have been asked about the vow of celibacy. Because he could buy viagra online, he avoided one of the methods for detecting inappropriate use. Not quite what the pharmaceutical companies would have had in mind, but it does fit their public safety concerns.

Those of you reading this are, of course, way ahead of me. You all know that adding a pinch of the little blue pill to the water of your cut flowers wards off droop for up to a week. It’s not the cheapest way of keeping flowers fresh but, if it’s that important to you, the remedy is in your hands. So what has all this to do with this article’s theme? To answer that, we need to go back to the history of the viagra. The first application that came up for clinical testing was as a treatment for pulmonary arterial hypertension (PAH). The drug dilates arteries. If the main arteries in the chest and lungs are constricted, this limits the flow of oxygen around the body and bad things happen. When the side-effect of erections was noticed, the researchers put PAH on the back-burner and focussed on making money — an understandable decision that has paid the bills at Pfizer for the last ten years. But good ideas never go away.

Now’s the time to meet Calvin Muteesa. This British boy has been taking viagra for 92% of this life. The daily dose is between four and six tablets. He started when he was three months old. He’s now thirty-three months old. The diagnosis of PAH was clear. His heart was struggling to pump the blood around his body. He could barely breathe. The effect of taking this “adult” drug was described by his parents as nothing short of miraculous. Within an hour, his blood pressure dropped and his breathing became more normal. Remember, the chemistry in the body works the same in arteries at strategic places all around the body. If a drug works to dilate the artery to relieve erectile dysfunction, it also works to relieve PAH. Quite what will happen to Calvin’s physical development is uncertain. Doctors will monitor him and adjust the dose if it seems necessary. So age is no barrier to the use of this drug. Viagra really does get the blood flowing where it should with all the desired results.