Tuesday, January 24, 2006

Widespread ED

Well, I just couldn't resist checking out this article when I got an email from the Archives of Internal Medicine: "Predictors and Prevalence of Erectile Dysfunction in a Racially Diverse Population." From the number of products available to deal with the issue, the amount of advertising that we are bombarded with, and the level of spam that shows up in my inbox, one can deduce that there is a lot of interest in the issue. The question that kept popping up in my mind (and I assume that of the researchers for this article) is whether ED was that significant a problem.

Problem or issue, the availability of ED drugs as party drugs is a concern to the HIV/AIDS community. One can't help but let that color one's thinking about all this advertising.

In step the reseachers (Christopher S. Saigal, MD, MPH; Hunter Wessells, MD; Jennifer Pace, BS; Matt Schonlau, PhD; Timothy J. Wilt, MD, MPH), and this is what they did:

Background To our knowledge, the burden of disease attributed to erectile dysfunction (ED) has not been adequately quantified across a complete spectrum of age and race using a global disease definition, as recommended by the National Institutes of Health consensus statement. To obtain a better understanding of the national estimates of prevalence and risk factors for ED, we analyzed data from the 2001-2002 National Health and Nutrition Examination Survey.

Methods The National Health and Nutrition Examination Survey collects data by household interview. The sample design is a stratified, multistage, probability sample of clusters of persons representing the civilian noninstitutionalized population. Data include medical histories in which specific queries are made regarding urological symptoms (including ED). These items were selected for analysis in 3566 men, 20 years and older.

Results In men 20 years and older, ED affected almost 1 in 5 respondents. Hispanic men were more likely to report ED (odds ratio [OR], 1.89), after controlling for other factors. The prevalence of ED increased dramatically with advanced age; 77.5% of men 75 years and older were affected. In addition, there were several modifiable risk factors that were independently associated with ED, including diabetes mellitus (OR, 2.69), obesity (OR, 1.60), current smoking (OR, 1.74), and hypertension (OR, 1.56).

Conclusions The burden of ED on the US population is significant. Hispanic men had an elevated risk for ED, a finding that requires confirmation in prospective studies. Obesity, hypertension, smoking, and diabetes mellitus are significantly associated with ED risk. Mitigation of these risk factors may ameliorate the burden of ED.

No doubt the manufacturers had an inkling of this when they were developing the drugs, and the FDA figured it out when it approved them. The contributing factors are widely studied as serious health issues in the nation, pointing us all more or less directly to the same conclusion that these scientists reached. The availability of this medication to treat a symptom of these serious conditions does not deserve to be the butt of jokes on late night TV.

This still leaves us with the question of how these drugs get to the street, where they triple in value and then get abused to reverse the effects of other abused drugs or simply to satisfy a male fantasy of superpotence. In the former case, impaired judgement can lead to the unsafe behaviors that promote the transmission of HIV. That's where our concern lies.

Arch Intern Med. 2006;166:207-212.

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