Unfortunately, this is all part of the general lack of accountability within the healthcare services. The present culture allows the pharmaceutical industry and the doctors to dictate the treatment standards based on what generates the most profit for them. The idea such people would actively seek evidence to show whether their cherished treatments were medically effective is a nonstarter. There’s no willingness to engineer a learning environment where everyone tries to improve. Rather everyone wants to avoid any liability for errors of judgement and mistakes. Imagine the litigation if it emerged that doctors had for years been advising we agree to ineffective treatments.

Until there’s a major change in the culture, we will have to look with envy at the approach of the Europeans in the pain management field. As a symptom of our problems, the words “pain management clinic” in Florida and certain other states usually indicates a borderline illegal operation to sell pills. We should modify all aspects of the current service. The first reforms should affect the health insurance industry and the public bodies like Medicaid and Medicare. At present, these administrators and business people simply pay out on the bills submitted by the hospitals, clinics and doctors. Since the taxpayers fund the entitlement systems and the rest of us with money pay ever higher premiums, there’s no pressure on insurers to demand value for money. They are not there to guarantee good quality care for their insured. All they do is pay out on the bills and pocket the rest as profit.

At present, it suits everyone concerned with pain management to do as little as possible. That means the shortest possible consultations followed by the prescription of one of the standard drugs, the most effective being Tramadol. This gives everyone in the healthcare services industry the maximum possible profit with the least possible effort. If they were to adopt the European model of one-to-one treatment by physical therapists, cognitive behavioral therapists, and so on, the labor costs would rocket and profit would decline. So there’s no chance of a team-based, patient-centric approach in our great nation. Further, any evidence that might show the European approach to be more effective in medical terms must be suppressed. Everything possible must be done to reinforce the current practice standards. That means you take another Tramadol and accept second best.

The government is the biggest buyer of drugs through Medicare and Medicaid. It has the power to negotiate with the pharmaceutical industry on the price for each drug. If it used this power, it could save the country billions of dollars and, as individuals within health plans, we would all see our premiums drop. All it takes is for the government to show a little concern for taxpayers. Except that would mean cutting the profits of the drug manufacturers and the President backed away from that during the first stages of trying to get the bill into law. He thought it was more important to get the votes for the law and worry about the costs later. Put another way he realized too many Democrats take lobby money from Big Pharma and would not vote for his law.

In other countries, governments direct the medical profession on what they are allowed to prescribe. So where there’s a choice, doctors are only allowed to prescribe generic drugs and not the brands. Even where branded drugs are still under patent protection, doctors in the public sector may not be allowed to prescribe the drugs if the regulators consider the prices too high. This leaves patients with the option of paying for the drugs out of their own pocket or, if they have private insurance, negotiating with the insurer to pay. Yes, this cuts into the profits of the drug companies, but which is more important? That a country should have an affordable healthcare service? Or that the profits of a few drug companies should be allowed to grow without limit?

A recent report on healthcare policy called for a revolution in the culture of American healthcare. It argued there should be a radical change in the attitude of both government and the insurers, forcing the pharmaceutical manufacturers and doctors to reduce their profits. Note the force of this article. It’s on a site encouraging you to use Tramadol as your drug of choice if you are in pain. This is the generic version of Ultram which is sold at significantly higher prices. This site is trying to be responsible in encouraging you to use the cheaper Tramadol. As an approved generic, it’s exactly the same as the more expensive brand. There’s no need to pay more.

It therefore comes as something of a surprise to see research from the Rambam Medical Center in Haifa. The clinical trial applied electric shocks to the penis, testicles and groin area generally as a treatment for erectile dysfunction. The results are claimed to show a high success rate, matching or exceeding the results achieved by taking pills of different colors, shapes and sizes. Unlike those who specialize in the use of electricity as torture, this team administered very low energy shock waves. Something the men were no doubt grateful for. So, after regular treatment with three hundred mini-shocks being applied within a three minute window, most of the men demonstrated a rapid rise to a hard erection the moment anyone approached them with electrodes or a cattle prod in hand. None of the participants complained of pain – either they were enjoying the experience or were frightened the voltage would be cranked up in the next session.

The claimed scientific effect of these shocks is to either stimulate the growth of new blood vessels or to encourage tired old blood vessels back into life. This has a significant advantage over the use of drugs. If new blood vessels are formed or the hardening of old vessels is reversed, this would represent a “cure”. All the drugs can do is produce a temporary dilation of the relevant arteries. They do not cure the underlying condition.

Ignoring the potential humor of threatening to attach electrodes to your gonads as a medical treatment, the skeptical Victorians were right. There never has been any convincing scientific evidence to show electricity is or can be an effective treatment for any condition. Which leaves the vast majority of men back where they started. Viagra is the best treatment for erectile dysfunction. No matter what the claims of the Israeli team to produce a long-term cure, the experience of taking one viagra gives more than enough time to enjoy a length period of sexual activity. To repeat the activity, take another pill. Anyone else should go to their local BDSM club.

Yet, looking around the US today sees a different landscape. Fourteen states have passed laws allowing the use of marijuana for medicinal purposes. Leading the way, as always, California has a proposition in the November midterms to legalize marijuana outright. What has happened to produce such a revolution? There are two answers. The first has been a general toning down of the rhetoric in favor of scientific debate. When marijuana was first criminalized back in the 1930s, the medical profession stood together and denounced the drug as a tool of the Devil, tempting people into sin and depravity. Today sees a significant number of doctors singing a different tune. First, a gesture to the traditional group: there is no doubt that smoking marijuana can and does cause lung cancer and, over time, there is evidence suggesting loss of memory and some brain damage. But there is also an impressive body of international evidence proving marijuana highly effective in giving pain relief. The use has to build up over at least six months. Once a stable concentration is achieved in the blood stream, it relieves chronic pain from arthritis, fibromyalgia, multiple sclerosis and cancers.

The second justification is fiscal. The sale of medical marijuana already makes a significant contribution to state funds through the tax system. In a recession, all contributions are gratefully received. If the outright legalization goes through in California, it is estimated the annual tax take will rise from about $200 million to $1.5 billion. It will also lead to a better system of regulation so that, like alcohol, its distribution can be controlled. None of this changes the need for “conventional” drugs to relieve pain. Tramadol in its different forms will remain the first response to moderate to severe pain. But in chronic cases, the continuing use of any drug can lead to dependence and the debate shifts. Which of the drugs is better when use may be indicated for years? In the fourteen states with Illinois perhaps about to join them, you have the possibility to buy marijuana rather than to buy tramadol is there to be freely made. Legalization has undermined the criminal gangs and reduced prices. The quality of the product is also guaranteed whereas, on the street, marijuana can be cut with many strange and sometimes dangerous substances. This is the practical reality on the ground and there is no point in trying to turn the clock back. Pain management in these states now includes marijuana. For those who disapprove, tramadol and the other traditional drugs remain available.