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Title: IN THE PUBLIC EYE ,  Urology Times, 00939722, Nov2000, Vol. 28, Issue 11

What’s on your patients’ minds? Likely, it’s what’s in the news about urology. Be prepared to answer their questions by reading these summaries of articles from consumer magazine, web sites, and other news source.

A report in Men’s Health states that diets rich in certain foods help prevent prostate cancer. Here are the magazine’s suggestions:

Tangerines. They contain tangeretin and nobiletinand vitamin C. Researchers found that a high-C diet may cut cancer risk by 23%.

Broccoli. A study of 1,200 men showed that those who regularly ate the most broccoli and other cruciferous vegetables reduced their risk by 41%.

Sweet potatoes and carrots. These vegetables contain 4,250 mg of beta-carotene, enough to help the body absorb all of the lycopene in tomatoes while possibly reducing risk by 32%.

Chicken. One breast offers about half of your recommended daily allowance of selenium. According to one study, men taking a selenium supplement for 4 1/2 years were 63% less likely to die of prostate cancer than those who take a placebo.

Whole wheat tortilla and beans. Both contain selenium and a heavy dose of fiber. Canadian researchers found that a diet high in soluble fiber lowered levels of PSA.

Watermelon. Like tomatoes, watermelon contains lycopene, which may reduce patients’ risk by as much as 40%. A single 1-inch slice has as much lycopene as four tomatoes.

Wheat germ. A study at the Fred Hutchinson Cancer Research Center showed that men who took supplemental vitamin E had a 20% lower risk of prostate cancer while those who took zinc daily had 45% less risk. Wheat germ is high in both.

Men’s Health

November 2000

High-dose chemotherapy followed by stem-cell transplantation offers new hope for testicular cancer patients who experience recurrence. For these patients, such intensive therapy can achieve a durable remission in approximately 50% of patients, according to a study conducted at Indiana University Medical Center, Indianapolis.

After an average of more than 3 years follow-up, 37 of 65 patients (57%) with recurrent testicular cancer were disease-free after receiving two rounds of high-dose chemotherapy followed by stem-cell transplantation. These results are significant, according to the study’s lead author, Lawrence H. Einhorn, MD, because if testicular cancer recurs, it often develops within a year after treatment. All patients in this study had a minimum follow-up of 16 months.

Currently, 70% of patients with the disease are cured with initial chemotherapy. This study shows that for the remaining 30% of patients who did not respond to the treatment or who later relapsed, more than half can be cured with a second round of intensive chemotherapy–bringing the overall cure rate to approximately 85%.

Intelihealth Health News

(www.intelihealth.com)]

September 29, 2000

Men who exercise regularly are less likely to become impotent, according to a long-term study. Compared with men who did not exercise, men who burned 200 calories or more a day in physical activity had far less risk of erectile dysfunction.

“If you do at least that, you can reduce your risk by half,” said Carol A. Derby, a researcher at New England Research Institutes, Watertown, MA. “Men who were sedentary had the highest risk.”

Derby and colleagues studied 593 men in the nearly 9-year Massachusetts Male Aging Study. The men (age range, 40 to 70 years) completed a mail-in questionnaire about their sexual health. None reported erectile dysfunction at the start of the study. At the end, 17% did.

“Even if you were sedentary at the beginning, the men who were active at the follow-up had a much lower risk, comparable to the people who were active at both time points,” Derby said. The findings make physiological sense, said Drogo K. Montague, MD, a urologist and head of the Center for Sexual Function, Cleveland Clinic Foundation. Regular aerobic exercise fights vascular disease, including fat clogs that narrow the arteries, said Dr. Montague, who is not connected to the study.

Such clogs can impede blood flow through arteries that engorge the penis, so exercise should help to keep those arteries healthy and clear, Dr. Montague said.

Associated Press

October 2, 2000

Where Americans live can determine the surgery they receive, according to a Dartmouth Atlas of Health Care series detailed in a page 1 article in USA Today. The Atlas report has sparked debates over whether patientsget full information about their options before surgery, including radical prostatectomy. These debates are likely to continue because, despite advances in health care, the geographic variations do not appear to be changing.

The article sites a recent JAMA study by researchers from the University of Massachusetts, Boston, that looked at how urologists and radiation specialists treated early-stage prostate cancer. The study found that 93% of urologists chose surgical removal of the prostate while 72% of radiation specialists chose radiation treatment. Few physicians chose watchful waiting.

“The problem probably reflects the educational background of surgeons,” said Thomas Russell, MD, of the American College of Surgeons.

Because medical training generally emphasizes decisiveness, the article says, more aggressive, young surgeons might seek out departments with aggressive reputations.

The article notes that, across 306 hospital regions studied by the Atlas researchers, radical prostatectomy showed the second highest variation in rates (after partial mastectomy). The Hattiesburg, MS, region has a radical prostatectomy rate of 4.2 per 1,000 Medicare patients, more than twice the national average, whereas too few prostatectomies took place in the nearby Oxford region for Atlas researchers to calculate a meaningful rate.

“When I sit down with patients, I can’t show them a ream of papers, but I can give them my honest opinion when discussing a radical prostatectomy,” Martin Resnick, MD, an AUA spokesman, said in the article. “The variation exists, but I think most physicians give a fair perspective.”

USA Today

September 19, 2000

The FDA has approved the Da Vinci Surgical System, a device to help surgeons perform certain laparoscopic procedures, Men’s Health magazine reports. Working behind a console, physicians use hand grips and foot pedals to operate the system’s three robotic arms. Experts believe that for some procedures, the robot will give physicians more dexterity than the human hand.

Men’s Health

October 2000

An American Cancer Society (ACS) expert says yearly prostate cancer screeming for men aged 50 years and older is valuable, despite a new study that suggests skipping the tests some years but starting them earlier may be more effective. (See also, “Earlier, less frequent PSA screens discover PCa.” page 1.)

“This study is interesting, but it really doesn’t provide the level of scientific evidence that would stimulate us to change our guidelines.” says Durado Brooks. MD. MPH. director of prostate and colorectal cancer programs for the ACS.

The new study, published in JAMA. used a computer method known as Monte Carlo simulation to estimate the number of lives that would be saved by giving the PSA test in each of seven different patterns, including the now common pattern of annual testing for men 50 and older. The researchers find the most effective testing strategy was to start at age 40, 40, repeat the test again at ages 45 and 50, and repeat it every 2 years thereafter.

“The standard strategy of annual PSA screening beginning at age 50 years appears to be less effective and more resource intensive compared with a strategy that begins earlier but screens biennially instead of annually,” noted Kevin S. Ross, MPH, of the department of epidemiology at the University of North Carolina at Chapel Hill.

ACS News Today

October 3, 2000

Title: You Can Patent That? ,  By: Stix, Gary, Scientific American, 00368733, Jul2003, Vol. 289, Issue 1

Section: Staking Claims

The U.S. Patent and Trademark Office issues several thousand new patents a week. Not everything that originates from the patent office is just another variation on a rotary valve or a mobile communications device. In each weekly batch, a number of issuances demonstrate both the scope of human ingenuity and the expansive breadth of what the patent office considers novel, useful and inventive. What follows are a few recent highlights that, if nothing else, transcend the mundane.

Sildenafil citrate chewing gum formulations and methods of using the same, patent 6,531,114, assigned to Wm. Wrigley Jr. Company. According to the text of the patent: “We claim a method for treating erectile dysfunction in an individual comprising the steps of providing a chewing gum composition that includes a therapeutically effective amount of Sildenafil citrate in the chewing gum composition.” Chewing causes the drug” to be released from the chewing gum composition into the oral cavity of the individual.” Sildenafil citrate is better known as Viagra.

Warren portal identification and tunnel resident disgorger system, patent 6,474,601, Richard Krobusek and David H. Hitt of Piano, Tex. A jet engine is aimed at the mouth of a cave. “Running the jet engine at idle … creates a significant volumetric flow of exhaust gases, including significant quantities of carbon dioxide and carbon monoxide,” the patent states. “These gases displace the oxygen that the terrorists require to breathe.” The engine can also be run at cruise power, which “causes significant airflow and force to be applied to those persons and objects in the warren. Therefore, the terrorists are assaulted through their sense of touch as they are blown about in the warren.”

Registered pedigree stuffed animals, patent 6,482,067, David L. Pickens of Honolulu. From the patent: “A pair of opposite sex ‘parent’ toy animals are sold together with a serial number by which the parent’s genotype and phenotype may be identified. The owner or owners of the ‘parent’ toy animals may register the parents with the manufacturer and subsequently request ‘breeding’ of the animals, whereupon the manufacturer makes at least one ‘offspring’ toy animal randomly selected from a litter having phenotypes [traits] determined according to the registered genotypes of the parents and the Mendelian laws of inheritance.”

Nervous system manipulation by electromagnetic fields from monitors, patent 6,506,148, Hendricus G. Loos of Laguna Beach, Calif. A pulsed electromagnetic field, from either a television set or a computer, can be created to manipulate the human nervous system, inducing sensations that range from relaxation to a “tonic smile,” to sexual excitement or “sudden loose stool.” Sometimes the pulses cannot be seen on the monitor. “This is unfortunate,” the patent notes, “since it opens a way for mischievous application of the invention, whereby people are exposed unknowingly to manipulation of their nervous systems for someone else’s purposes. Such application would be unethical and is of course not advocated. It is mentioned here in order to alert the public to the possibility of covert abuse that may occur while being online …. “

Semen taste-enhancement dietary supplement, patent 6,485,773, Lois Kay Myers and Brent Richard Myers of Apache Junction, Ariz. Details can be sought by getting in touch with the U.S. government. Go to the patent and trademark office site (www.uspto.gov) and type in the patent number in the “search patents” section. Then read about a formulation that could complement the aforementioned Wrigley patent.

More offbeat patents will be included in next month’s Staking Claims column.

~~~~~~~~

By Gary Stix

Title: VITAL STATISTICS ,  Health, 1059938X, Apr2000, Vol. 14, Issue 3

               2
Gallons of wine consumed, per capita,
in the United States each ,year 
	
               17
Gallons consumed in Luxembourg 
	
               19
Percentage of snorers who can be
heard through a closed door 
	
               41
Percentage of homemakers who say
they avoid cooking with fatty foods 
	
               40
Percentage increase in
sales of deep fat fryers in 1999
compared to 1998 
	
               105
Number of common drugs known
to cause  impotence  
	
              136 million
Number of tablets of
Viagra prescribed since 1998 
	
               60
Minutes that follow decapitation
before a rattlesnake loses
its ability to bite 
	
Unless otherwise noted,
statistics apply to the United States.

Title: ARE YOU…’HEALTHY’? ,  By: Buckley Jr., Wm. F., National Review, 00280038, 07/06/98, Vol. 50, Issue 12

Section: On The Right

Dateline: NEW YORK, JUNE 5

Dr. Sherwin Nuland of the Yale School of Medicine raises the interesting question: Are we moving in the direction of asking the medical profession to enhance life and, along the way, to prolong it? Dr. Nuland’s concerns have to do with the vectors of medical research, and how they bear on the public definition of health. The search for that definition brings along a whole trainload of ancillary questions, among them, Is this something that should be covered by insurance or federal aid or health maintenance organizations? For instance?

Well, viagra has received the most notice in recent months, and the attitude toward it of reigning arbiters of federal aid is unsettled. One analyst says distinctions need to be drawn on viagra as needed by elderly men to fulfill passionate — needs? inclinations? diversions? Everything, in the judgment of such as that analyst, depends on distinguishing which of the three it is. But that inquiry is as a practical matter pretty difficult to bring off, and raises the whole question of enhancement of life as distinguished from the curing of infirmity.

Dr. Nuland lists other current drugs. Prozac relieves depression, but the widespread use of it suggests (this is now your pundit talking, not Dr. Nuland) that many are taking it as a Feelgood pill. But what about Propecia, which is said to mitigate, or even relieve, baldness? Is such relief an exercise in medical concern, traditionally understood? Anybody can make the case for anything, granted, but it is less than shamanism to contend that, hair on the head being natural, the lack of hair on the head draws attention and, contingently, affects the mood. The decent limits to self-esteem are not exceeded by men who wear toupees or use Propecia, nor by women who use cosmetics and go in for face-lifting.

But a lot of that kind of thing brings on sure-enough hubris. “Manipulation of the cellular aging mechanism raises expectations of human life extended indefinitely.'’ Dr. Nuland gives us the absolute barrier on that kind of dreaming. The human species is built to last a maximum of 120 years. Nothing can change that. What can be done is to edge up toward that limit, an asymtotic approach. Whereas at the turn of the century we could expect to live 45 years, now we can expect to live 75, and we are presumably continuing to edge in the direction of longevity, always on the understanding that the biological limit can’t be crossed.

All such developments continue to remind us of the auto-hypnosis in which so many of us are caught up. To say that everyone in America has the “right'’ to health treatment is of course to say that everybody in America has the duty to provide health treatment. The very abbreviated perspective gives you Mr. Jones charging his doctor’s bill via Medicare — to somebody else. As once put in this space, health care is defined as somebody else paying for it. The medical saga dramatized by Dr. Nuland in an essay for the New York Times is the galloping expansiveness of care that creeps in under the umbrella of “health'’ for reasons we can’t simply dismiss as semantical. We are pretty well habituated to understanding that psychological care is plainly a matter of health, and if a man’s psychological health rests on his ability to do something about his baldness, why isn’t that an exercise of that right we begin by saying all Americans have?

In his famous book, How We Die, Dr. Nuland reminded us of the facts of death. That was only four years ago, and he spoke of AIDS as perhaps the most “devastating'’ of deaths, probably “now with us for the duration of human history.'’ But the treatment of AIDS is now much advanced, and there is talk of moving in the direction of a vaccine. And the big news is Dr. Judah Folkman’s two drugs capable of destroying sizable cancerous tumors in mice.

Dr. Nuland is now giving time to the Bioethics Committee of the Yale -New Haven Hospital. He writes with some pride about the brilliance of modern medical research, but pauses pregnantly to wonder whether there is the requisite wisdom. “Absent from many news reports are the uncertainty and hedging characteristic of the clinically directed research. And of course the often well-justified enthusiasm and optimism of the scientists themselves carry public opinion along in a powerful wave of assurance.'’

~~~~~~~~

By Wm. F. Buckley Jr.

Title: WHAT MIKE WALLACE DID NOT KNOW ABOUT SMOKING ,  Urology Times, 00939722, Dec98, Vol. 26, Issue 12

Section: In the Public Eye

Mike Wallace called it a story “the tobacco companies were hoping you’d never hear.”

“Does smoking cause impotence ?” the co-editor of CBS’s 60 Minutes asked urologist Culley Carson III, MD, of the University of North Carolina at Chapel Hill.

“There’s absolutely no question about it,” Dr. Carson responded. “It causes it very commonly.”

Efforts are underway to publicize the tobacco- impotence link, including unabashedly blunt TV commercials airing in California.

60 Minutes
November 8, 1998

Title: ERECTILE DYSFUNCTION ,  Geriatrics, 0016867X, May98, Vol. 53, Issue 5

WHAT’S NEW

Oral Sildenafil citrate (Viagra) has been approved for the treatment of erectile dysfunction. It is the first of a new class of agents known as phosphodiesterase type 5 inhibitors, which improve blood flow to the penis. Data from 4 of 21 randomized, double-blind, placebo-controlled trials show that patients treated with Sildenafil reported notable improvement in achieving and maintaining erection. Recommended dosage is 50 mg as needed, approximately i hour before sexual activity. Maximum dosing frequency is once daily. Most frequently reported side effects were headache, flushing, and dyspepsia.

Title: viagra ,  Consumer Reports, 00107174, Jul98, Vol. 63, Issue 7

Section: Your Health

The media have played up Pfizer’s little blue pill as a miracle remedy for impotence ever since the Food and Drug Administration approved it in March. Does it work? You bet - which is why doctors have been writing 300,000 prescriptions a week, at about $10 per pill.

But the media have mostly played down or ignored viagra ’s potential health hazards and side effects, despite a two-part study of 861 patients sponsored by Pfizer and published in the May 14 issue of The New England Journal of Medicine. The study indicates that side effects may occur more often than stated in the patient insert packed with the drug.

Also known as sildenafil, viagra was developed originally as a heart drug for angina patients. Its effectiveness as a treatment for impotence came as a complete surprise. The drug enhances the effects of nitric oxide, a chemical normally released by the body in response to sexual stimulation. Nitric oxide relaxes the smooth muscles and widens the blood vessels in the penis, increasing blood flow and enabling an erection to occur.

viagra also widens other blood vessels in the body, temporarily reducing blood pressure slightly, so some doctors have been wary of prescribing viagra for cardiac patients. However, common blood-pressure medications like ACE inhibitors, beta blockers, calcium channel blockers, and diuretics should be OK. So far, the only cardiac drugs identified as a hazard are nitrates, like nitroglycerin (Nitrostat, Nitro-Bid) and isosorbide (Imdur, Isordil), used to relieve chest pains. Taken with viagra , nitrates could lower blood pressure to life-threatening levels. (About 5 percent of impotent men take nitrates.)

“Suppose a patient takes viagra , has intercourse, and then has chest pains,” says Dr. William Steers, chairman of the department of urology at the University of Virginia and one of the authors of the report in The New England Journal of Medicine. “If he then takes nitroglycerin, it could be the last time he’ll have sex.”

For patients who aren’t on nitrates and whose cardiac condition is stable, there’s no reason at present to withhold viagra , according to Dr. Elizabeth Ross, a Washington, D.C., cardiologist and a spokeswoman for the American Heart Association. “If there are problems, we’ll see them very quickly because of the large number of people taking viagra .” (At press time, the FDA was investigating the deaths of six viagra users to see whether interaction with nitrates was involved.)

Ross adds, “All heart patients need to be cautioned about vigorous activity, and sex can be a vigorous activity.”

And then there’s the tendency of viagra to produce blue-tinged, blurred vision and light-sensitivity in some patients. In May, the American Academy of Ophthalmology issued this warning: “On the surface, seeing the world with a bluish tinge may just be annoying. It is not known, however, whether or not the drug causes any permanent changes in vision.” The problem may occur soon after the drug is taken and persist for several hours.

viagra “cross-reacts with a chemical in the visual cells in the retina,” says the academy’s spokesman, Dr. Michael Marmor, a professor of ophthalmology at the Stanford University School of Medicine. “It’s always having a physical effect on the retina, and I’m not sure we have enough long-term data to know that damage isn’t being caused -especially since many men taking this drug have underlying retinal problems.” He also thinks the temporary light-sensitivity might pose a problem for some drivers, particularly at night, with headlight glare.

Pfizer’s patient insert packed with each bottle of viagra indicates that side effects are relatively rare. A Pfizer spokesman says the information in the insert is based mostly on a compilation of as many as 10 safety and efficacy trials in which 734 patients were on various dosages of viagra and 725 on a placebo. But the two-part study published in The New England Journal of Medicine shows a much higher incidence of side effects predominantly among patients taking higher dosages.

The insert says, for example, that viagra may cause headaches in about 16 percent of users, but the Journal study recorded headaches in up to 30 percent of users. The insert also indicates facial flushing in 10 percent of users (vs. 27 percent in the Journal study). A prominent table in the insert lists a 7 percent rate of acid stomach and a 3 percent rate of abnormal vision, including the blue tinge, light-sensitivity, and blurred eyesight discussed earlier. But reading further discloses that, at a 100-milligram dosage, the rates actually ranged to 17 and 11 percent, respectively - similar to the results reported in the Journal study.

As with any new drug, it will take “thousands, tens of thousands, millions of patients,” says Steers, “before you find the unusual side effects.”

The instant popularity of viagra isn’t hard to fathom. Taking a pill about an hour before having sex is clearly more appealing than any alternative medical treatments for impotence - penile injections, urethral suppositories, vacuum pumps, and implants.

“You can take the pill and do nothing, and you’ll never know you took anything,” says a 61-year old viagra user who’d been impotent since prostate surgery in 1991. “But with stimulation, I stay erect until orgasm.”

However, not all 30 million U.S. men who are impotent can expect such happy results. In part one of the two-part study in the Journal, 532 patients took a 25-, 50-, or 100-milligram dose of viagra or a placebo. After 24 weeks, 72 percent of the men on the lowest dose and 85 percent on the highest dose achieved an erection sufficient for sexual intercourse at least about half the time. (Surprisingly, so did 50 percent of men taking the placebo.)

In part two of the study, 329 men started with a 50-milligram dose of viagra or with a placebo, and they could double or halve the dose as needed over 12 weeks. Researchers followed up with the viagra patients for another 32 weeks. By the end of the trial, 69 percent of attempts at intercourse were successful with viagra , vs. 22 percent with the placebo.

Results are less promising in Steers’ as-yet-unpublished study of 1,418 men with the most “severe” impotence. Of those who took 50 or 100 milligrams of viagra for eight weeks, only 46 percent were able to have intercourse at least “most of the time.” For the placebo, the success rate was 8 percent.

Chronic illnesses such as hypertension, diabetes, severe kidney problems, neurological disorders, and emotional problems can lead to impotence. According to Pfizer’s data, viagra allowed sexual intercourse less than 60 percent of the time for men with spinal-cord injuries, 50 percent for diabetics, and 43 percent for men who’d had a radical prostatectomy.

In an editorial in the May 14 issue of The New England Journal of Medicine, Dr. Robert Utiger, a Boston endocrinologist and a deputy editor of the Journal, termed the results “promising,” noting anecdotes of “nearly miraculous restoration of sexual function.” But he concluded that the promise of sildenafil won’t be realized until many more men are treated for prolonged periods.

If you decide to try viagra despite the potential for side effects:

• Have your doctor give you a physical exam, take your medical history, and review medications you’re taking.
• Ask your doctor how to take the pill. Steers says that taking it with milk or dairy products or on a full stomach may delay absorption.
• Find out who’ll pay. Some medical insurers will cover a few pills per month.
• Consider how the drug will affect your mate or partner. Dr. Drogo Montague, director of the Center for Sexual Function at the Cleveland Clinic, tries to involve the patient’s wife in choosing options.

The pills come in 25-, 50-, and 100-milligram doses. Pfizer recommends starting with 50 milligrams and increasing or decreasing the dosage as needed. Currently, the pills are selling for about $10 each, regardless of dose. (Some doctors are prescribing 100-milligram pills and telling patients to split them to save money - although a Pfizer spokesman advises against that, saying the pills aren’t scored and may not split evenly.)

Don’t take viagra if you’re not impotent. It’s not an aphrodisiac. Nor does it improve sexual performance in men who can achieve a healthy erection.

ILLUSTRATION

Since viagra helps some men left impotent from prostate surgery, might it also help women who are unable to achieve orgasm because of a hysterectomy or other pelvic surgery, or chronic disease such as hypertension or diabetes?

Dr. Jennifer Berman, a urologist at the University of Maryland Medical Center in Baltimore, has enrolled 22 such women, ages 25 to 41, in a viagra study funded by the American Foundation of Urologic Disease, an academic medical association. Many of them said that since their surgery or onset of illness, they’d felt decreased sexual sensations, had problems lubricating, and had difficulty achieving orgasm.

Berman thinks viagra might help by increasing blood flow to the genital area and allowing the smooth muscles of the vagina to relax. Her pilot study is small, and all the data aren’t in. But so far, she says, most of the women have had “positive responses,” including achieving orgasm. For the most part, the women are reporting the same side effects as men, says Berman. And presumably, the health hazards will be similar as well. However, because viagra ’s long-term effects on fertility are unknown, women who could bear children are being excluded from the study.

Berman plans to continue her research in her new position as director of the Women’s Sexual Health Clinic at the Boston University School of Medicine. For more information, call 617 638-8555 or send e-mail to igoldst@bu.edu.

Q. My mother always told me to eat the skin of the potato because the vitamins were just underneath the skin. Is this true?

A. Yes. The skin and area just underneath are richest in fiber, iron, calcium, phosphorus, potassium, zinc, and B vitamins. To remove dirt and pesticide residues, scrub the potato with a vegetable brush, using soapy water, and rinse thoroughly. Cut away parts with a greenish tinge, indicative of a high concentration of solanine, a natural toxin. If your budget allows, consider buying organically grown produce to minimize pesticide residue.

Q. Could I use a saline solution that’s sold for cleaning contact lenses as a nasal spray as well? My eye-care product costs just 17 cents an ounce, while my nasal spray runs about $1.27 an ounce.

A. There’s no reason not to. Sterilize the nasal-spray bottle by boiling it in water for a few minutes each time before you refill it with the less expensive saline.

Q. I’ve suffered monthly menstrual migraines for the last 12 years. I’m 50 years old. Would an estrogen patch help?

A. Possibly. Although not proved in clinical trials, an estrogen patch on days one and two of the menstrual cycle may be of help with menstrual migraine. It’s certainly worth a try, so talk to your doctor.

ILLUSTRATION

Address questions about health and medicine to: Consumer Reports, Dept. DA, 101 Truman Ave., Yonkers, N.Y. 10703-1057. Letters may be condensed, and will be answered with the help of CU’s medical and dental consultants. We are unable to respond individually. Additional reports on personal health can be found in Consumer Reports on Health, a 12-page monthly newsletter. To subscribe, call 800 234-2188.

Title: TARGETED RADIATION MAY CAUSE POST-RT impotence ,  By: Bankhead, Charles, Urology Times, 00939722, Sep2000, Vol. 28, Issue 9

Atlanta–The base of the penis receives substantial exposure to radiotherapy targeted against prostate cancer even with the best conformal radiation techniques, suggesting an explanation for the significant rates of post-radiotherapy impotence .

“Our analysis revealed that the proximal-most 1-cm segment of the corpora bodies received almost 96% of the intended treatment dose that was supposed to land on the prostate,” explained Paul Yonover, MD, during a presentation at the annual AUA meeting. “The second and third centimeters received 68% and 20% of the intended therapeutic dose. The three segments combined received 65% of the intended dose of radiation therapy.”

Despite advances in targeting external beam radiation to the prostate, the literature reveals post-irradiation erectile dysfunction rates ranging between 25% and 62%, said Dr. Yonover, a surgery resident at Loyola University, Maywood, IL, working with John Mulhall, MD, director of the male center for sexual dysfunction.

The mechanism of radiation-induced impotence remains undetermined, but several hypotheses exist, Dr. Yonover said.

“Although the nerves are thought to be relatively radiotherapy-insensitive, there is growing concern that nerve injury is occurring with radiation exposure,” he said.

Preclinical studies have demonstrated a dose-dependent decrease in nitric oxide-containing nerves in the cavernous smooth muscle of rats after exposure of the prostate to external beam radiation (Radiology 1995; 195:95-9). Acute smooth muscle fibrosis also may occur after radiation exposure, which might induce venous leak and possibly play a role in post-radiation impotence , said Dr. Yonover.

Loyola investigators retrospectively evaluated radiation exposure to the cavernosum in 13 prostate cancer patients. All patients had T1-T2 disease and received standard 3-D conformal radiation therapy. In all cases, the clinical target volume (CTV) was defined as the prostate and seminal vesicles, and the planning target volume was the CTV surrounded by a 5- to 10-ram margin. The mean radiation dose to the prostate was 7,400 Gy.

Computer analysis of the 3-D images generated for conformal radiotherapy revealed that the most proximal centimeter of the corpora bodies received an average radiation dose of 7,129 Gy, Dr. Yonover reported. At the second most proximal centimeter, the dose remained high at 5,083 Gy. The third most proximal centimeter of the corpora bodies received an average radiation dose of 4,683 Gy.

“These data indicate that large doses of radiation therapy are being administered to the proximal regions of the corpora bodies despite using conformal techniques,” said Dr. Yonover. “The doses of radiation to the base of the penis may explain the significant rates of post-radiation therapy impotence .

“This model might also be used to analyze other modalities of radiation therapy, including brachytherapy and [intensity modulated radiotherapy],” he said. “Such data may also lead to greater efforts to exclude the penis from the planning target volumes associated with conformal radiation therapy.”

Dr. Yonover noted that the issue of postradiation impotence will likely grow in significance as more prostate cancers are detected each year by PSA screening. Additionally, more cases of prostate cancer are being detected in younger men, in whom post-treatment sexual potential will be an even greater issue.

“There is increasing pressure not only for more effective treatment of prostate cancer but also less morbid treatment modalities, with special emphasis on sexual dysfunction,” he said. “We have already observed a trend among urologic oncologists and radiation oncologists to refine their respective therapies for localized prostate cancer. However, the available data suggest that radiation-associated erectile dysfunction still occurs in a substantial number of prostate cancer patients, despite refinement in the techniques.”

Targeted RT off the mark >> Even with the best conformal radiation techniques, high doses may still reach the base of the penis, perhaps explaining the significant rates of post-RT impotence .

~~~~~~~~

By Charles Bankhead, UT Contributing Editor

Title: YEAR IN REVIEW: PRODUCTS ,  Advertising Age, 00018899, 12/21/98, Vol. 69, Issue 51

DROOPING FEELING? NOT HERE

PRODUCTS: IMAC viagra TELETUBBIES DIAL AROUND `BRILL’S CONTENT’ MACH3 OLEAN COLGATE TOTAL TITANIC ST. JOHN’S WORT

viagra gets a gig on Leno, Letterman

Pfizer got a rise out of its breakthrough prescription impotence treatment, viagra . The product touched a cultural nerve. It became the source of countless jokes and the subject of governmental and insurance debates over who should pay for it. A reserved print ad campaign appeared in July. A companion $35 million TV effort from Cline, Davis & Mann, New York, will run in 1999. And Bob Dole joins as the pill’s new pitchman.

DIAL AROUND

Any questions about the importance and future of dial-around long-distance services were put to rest late in the year when AT&T Corp. released the Lucky Dog Phone Co. AT&T earlier had conceded it was losing $1 million a day in charges to the hundreds of dial-around providers led by MCI WorldCom, which started aggressively advertising its products in 1997.

TELETUBBIES

The British invasion of the ’90s was a band of four baby-talking, teddy bear-like creatures. They star in “Teletubbies,'’ the Public Broadcasting Service program created in the U.K. by Ragdoll Productions. The show first ran on the BBC and became a global property as international licensing and merchandising efforts were pursued. The Teletubbies also are omnipresent thanks to the explosion of licensed products from books and games to yogurt and videos.

TITANIC Unlike its namesake, the film “Titanic'’ refuses to go down. In spite of dire predictions the flick would sink under the weight of its $65 million production costs, it was a spectacular box-office success, grossing $600 million in the U.S. and more than $1.1 billion everywhere else. Director Jim Cameron was heralded a genius, the stars made audiences swoon and the soundtrack sold 12 million units. It attracted tie-ins galore, and its success is so epic it may be a coincidence that DreamWorks Pictures chose to launch “Prince of Egypt'’ on Dec. 19, the same date the film “Titanic'’ set sail.

COLGATE TOTAL

The buzz for Colgate Total started overseas as U.S. travelers purchased the item by the caseload-before Colgate-Palmolive Co. got approval to sell it in the U.S. Colgate projected a 6% market share in its home country for Total, and by November, the product had a stable 9% share of the $1.6 billion category, according to Paine-Webber analyst Andrew Shore.

OLEAN

Procter & Gamble Co. brushed aside complaints from watchdog group Center for Science in the Public Interest and received a clean bill of health from U.S. Food & Drug Administration for Olean in June. That followed three major national Olean launches: P&G’s Fat-Free Pringles and its Portland, Me., test of an Eagle brand corn chip, plus Frito-Lay’s Wow! chips. Although Wow! was showing sales of up to $40 million a month-which for many other products would be considered a home run-analysts who had predicted blockbuster status were closely watching dips in sales results on a month-to-month basis.

MACH3

Living up to expectations is hard when the product takes $750 million to develop and $300 million to market, but the numbers turned in by Gillette Co.’s new razor since its June launch have been impressive by most standards. Cumulative sales of Mach3 passed $100 million in November. The launch pushed Gillette’s monthly share of the combined $850 million razor and blade market to 70%, up 2.7 points from November 1997. But Gillette’s third-quarter earnings stumble, some seemingly disappointing shipment data and reports that some men have trouble using Mach3 in tight spots, are still casting a shadow.

ST. JOHN’S WORT

As herbal remedies marched into the mainstream this year, St. John’s Wort was one of the most sough- after supplements. The herb earned the helpful nickname “nature’s Prozac,'’ referring to the Eli Lilly & Co. antidepressant drug, and garnered handwritten signs in store windows to announce its arrival. Primarily marketed by a number of smaller manufacturers, Pharmaton Natural Health Products broke the first national TV campaign behind Movana, a $15 million effort from Sawtooth Group, Woodbridge, N.J.

`CONTENT’ gets close & personal

Promising to expose the media, warts and all, Brill’s Content was launched in a blaze of publicity. The first cover story, analyzing the performance of the media in covering the Monica Lewinsky-Bill Clinton scandal, was touted by The New York Times. Founder Steven Brill then appeared on a round of talk shows defending the piece, which accused Special Prosecutor Ken Starr of inappropriately leaking crucial information to the press. So rather than just reporting on how others were covering the news, Brill’s Content itself became part of the Monica-Bill-Ken news saga. In recent months, the title has seen a fair amount of turnover in editorial staff, topped by the departure of Editor Michael Kramer.

iMAC brings Apple back from oblivion

Apple Computer brashly reentered the consumer market in August with the launch of iMac, a sleek $1,299 computer backed with a highly acclaimed $100 million ad blitz. iMac quickly became the No. 1-selling PC in U.S. computer superstores. Apple’s U.S. retail PC share more than doubled from 2% in June to 4.4% in October, but that was still only good enough for sixth place. With the expected launch in early ‘99 of a cheaper iMac and a return to the Super Bowl next month for the first time in 14 years, Apple aims to keep staging its big Mac attack.

PHOTO (COLOR): viagra Ad

PHOTO (COLOR): Lucky dog

PHOTO (COLOR): Teletubbies

PHOTO (COLOR): Colgate Total

PHOTO (COLOR): Titanic ‘tie-ins’

PHOTO (COLOR): MACH3 Ad

PHOTO (COLOR): Olean Ad

PHOTO (COLOR): ‘Content’ cover

PHOTO (COLOR): iMac

Title: IMPOTENCE CLINIC FLOPS IN WAKE OF viagra ,  By: Hofman, Mike, Inc., 01628968, May99, Vol. 21, Issue 6

Section: OBITS

THE BUSINESS: Treatment centers for male sexual impotence

OPENED: 1990

CLOSED: December 1998

CAUSES OF DEATH: Competition created because of the availability of a powerful new drug; overly rapid expansion

In early 1998, just before Pfizer introduced viagra , its drug for male sexual impotence, the pharmaceutical giant’s stock price rose in anticipation by 27%, hitting a peak of $96.38 a share by the drug’s kickoff date of April 15. Impressive, but nothing compared with the run-up in the stock of Integrated Medical Resources Inc. (IMR), a national chain of clinics that specialized in diagnosing and treating impotence.

IMR shares went through the NASDAQ roof in the same period, rising from $1.63 to $4.63, up a staggering 185%.

At IMR’s headquarters, in Lenexa, Kans., executives shared Wall Street’s view that viagra would have as miraculous an effect in invigorating the company’s bottom line as in combating American men’s impotence. “The viagra craze is bringing the problem of impotence out of the closet,” Dr. Stanley Kardatzke, IMR’s chairman and CEO, told the Kansas City Business Journal. Kardatzke was right–more men did seek treatment, but not the kind that IMR was in the business of providing.

Of course, when IMR was founded nine years ago by Troy Burns, a young internist, viagra wasn’t available. Burns had to offer other therapies like penile implants and injections. That’s what Burns, now 37, had done in Olathe, Kans., near Kansas City, where he opened a clinic in 1990 to diagnose and treat impotence. His success in Olathe inspired him to go national with IMR, opening clinics named the Diagnostic Center for Men.

Just five years later, IMR’s mini-empire comprised 30 clinics from Boston to San Diego and was generating $11 million a year in revenues. To Burns the company’s prospects looked bright. “As the baby-boom generation approaches retirement age, the number of cases of impotence will [likely] increase,” noted the company’s annual report in 1996. An initial public offering that year, underwritten by Hambrecht & Quist, raised $13 million to fund further expansion.

But the high-octane growth proved difficult for Burns to manage, and IMR posted a loss of almost $8.5 million in 1997. Kardatzke, known for having built Wichita-based Physician Corp. of America into a $1.5-billion health-maintenance organization, took over from Burns in April 1998 and quickly injected $1.6 million of his own money into IMR. His plan to save the company was two-pronged: to achieve economies of scale by acquiring impotency-treatment centers in cities like Atlanta and Richmond, Va., and to spend heavily on advertising.

With Kardatzke’s plan scarcely under way, Pfizer unveiled its revolutionary blue pill. viagra did cause more patients to visit IMR’s clinics, but the company’s per-patient revenues slumped from about $650 to $450. “The men who came to IMR for viagra wanted to leave the office with a fistful of pills,” explains Jerry Duggan, a securities analyst in Leawood, Kans. “Men wanted a prescription without a diagnosis.” For every patient who went to IMR’s diagnostic centers, countless more flocked to the nation’s 261,000 primary-care physicians or 10,000 urologists for a prescription.

On November 5, IMR failed to make payroll and 26 days later entered Chapter 7 bankruptcy. Kardatzke couldn’t be reached for comment, and Burns declined to be interviewed. About that time, in an ad made for IMR, Len Dawson, the fabled former quarterback for the Kansas City Chiefs, was extolling the care he had received for impotence after prostate-cancer treatment. But only two weeks into the ad campaign, the spot was knocked off local TV for good.

PHOTO (COLOR): DEFUNCT: Integrated Medical Resources closed all its impotence-treatment clinics nationwide, including the Diagnostic Center for Men in Overland Park, Kans.

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By Mike Hofman