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Medical treatments can take years to go from new technique to standard therapy

Published: April 2, 2015

Medical treatments can take years to go from new technique to standard therapy.​ In 1747 James Lind showed that lime juice prevented the scurvy ravaging the British Navy, but it took 48 years to put limes in sailor’s rations.

Erectile dysfunction now shows a similar delay. Good drugs to treat it have been around 19 years. In 1996 alprostadil proved itself a safe, effective injectable drug. Oral ED medication arrived two years later with Viagra, itself soon joined by other pills – which work in about 60% of men. Injectable medicines remain effective for MOST men with whom pills fail.

Alprostadil has been joined by combo meds. “Bimix” is papaverine & phentolamine. Combinations of all three are “Trimix”. The FDA rates all as effective: alprostadil in solo use, the other two in combination. Trimix – all three – has not also been certified because formal tests have not been submitted to the FDA. But obviously if drug 1 works, and drugs 2&3 work, then so must 1,2 and 3.

Despite such good drugs now being available 75% of men get no treatment prescribed for ED. This is doubly alarming if we consider patients treated for prostate disease. With surgery/radiation to the prostate a high percentage of patients get ED. Even biopsies may cause problems. Also, men saddened over a lack of sexual functioning may be given anti-depressants, which themselves may cause sexual dysfunction.

Doctors can be uncomfortable talking about sex. And our reproductive system, unlike other body functions is OPTIONAL. For both reasons HMOs and insurers put ED treatment on the back burner. We see many patients whose doctors have failed to even attempt a remedy for their problem.

Sometimes men who developed trouble after prostate treatments are given pills. This usually fails. Pills depend on intact nerves to work, but those nerves have been injured (this happen even with hi-tech surgery). When ED develops – and the man asks what ELSE is available he is often told “nothing” except surgery. Implant surgery does not have a high rate of success, but it is covered by insurers so it is recommended as a treatment of last resort. We say that surgery should not be considered until Trimix has been attempted.

Urologists know about Trimix, but often they often do not offer it to patients. An ED evaluation including a test shot takes 90 minutes. Not every doctor can commit to this, but we think it wrong NOT to refer to someone who will.

The failure to treat ED – and utilize the effective tools medical science now has at its disposal for decades (including injectables) is inexcusable. If your doctor is not addressing this issue, you need to talk to us.