Bull Wang Gib You POWER!

File this under Travellers' Warning.

Yesterday's mood distortion was not caused by a batch of fake Cialis from Thailand, though some was offered to me on the street last time I was in Bangkok.

"Where you go? Body massage, girl, DBD porno, Viagah, Chalice?" is the chant of the superfluous tuk-tuk drivers along Sukhomvit Rd as they accost me on each Soi corner. Meanwhile I try to avoid stepping on the ragged women beggars, sitting cross-legged by the steps to the train, drugged children comatose on their laps. And try to avoid twisting my ankle on the Indiana Jones-like stepping-puzzle they call a footpath here.

Rather than the usual worn fold-up ad for a three-girl soapie and massage, the tuk-tuk driver may hold open a plastic bag, showing me the blue or orange box of the potency drugs.

I don't buy anything from these guys. No matter what you do or where go on a tuk-tuk these days, you will be ripped off. When I first came to Thailand they were a legitimate form of transport, much cheaper, faster and more available than taxis. Now, with the traffic at lock-jaw levels, tuk-tuks are just as stuck as ordinary cars. And they charge enormous amounts of money. Demands of 200Bht for a trip that would cost 45Bht in a A-C taxi are not to be believed. A motor-cycle taxi is the only way for serious commuters to weave through the cars, though chances of smashing a knee are pretty high. As often as possible, I take the sky-train.

Tuk-tuk drivers can only make their money by scamming you, the wide-eyed, wet-eared tourist. Selling erectile dysfunction medication is their latest beat.

On the odd occasion I might have made discreet purchases of ED drugs while travelling, it would have been in a "legit" pharmacy in Bangkok while getting a top up on my other medications: blood pressure, cholesterol and nerve-pain. Mmm, I hope they were legitimate drugs (Don't we? You know who!) I bought. They certainly cost enough - like full price, but without the added cost and embarrassment of seeing a physician to get a 'script.

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I can't bring myself to get some here. I imagine my cute female GP asking me, "How much do you need? When will you use it? How often?"

What am I going to say - the truth?

"I don't KNOW, I DON'T KNOW! Cheeerist woman, leave me alone with your incessant cataloguing of my personal failures! I KNOW I AM OVERWEIGHT, alright!? I KNOW that's the cause of almost all my problems, alright! I just need to have some Viagra handy in case I get so despairing in my pathetic lonely existence that I am prepared to suffer the ignominy and shame of picking up a bored and desperate Triad-run hooker in the ultra-sleazy 4FoWs and attempt to have sex with her even I don't even know or like her and she speaks no English and when I can't get it up... again... I'm a failure because I've wasted $250 not to mention taxi fare, and my life is shit, I don't know why I even bother breathing...!"

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OK, moving on.... I think we can all agree it'd be for the best if I pick the occasional batch up when I get to Thailand and avoid that scene all together, right?...

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So this article in the New England Journal Medicine is a bit of a warning:


An Unusual Outbreak of Hypoglycemia

Pasted from NEJM

To the Editor: The off-label use of drugs for the enhancement of sexual performance in persons without erectile dysfunction is a phenomenon that is increasingly recognized.1 These drugs are available in illegal forms, including counterfeit versions of brand-name drugs for the treatment of erectile dysfunction and purported herbal remedies containing synthetic phosphodiesterase type 5 inhibitors.2 We describe an outbreak of severe hypoglycemia in Singapore; this outbreak was associated with contamination of illegal sexual-enhancement drugs with glyburide.

Between January 1 and May 26, 2008, a total of 150 nondiabetic patients with severe hypoglycemia were admitted to the five public hospitals in Singapore. All the patients except one were men, and they ranged in age from 19 to 97 years (median, 51). Seven patients remained comatose as a result of prolonged neuroglycopenia, and four subsequently died.

Glyburide was detected in blood or urine samples obtained from 127 of these patients (85%). On specific questioning, 45 patients (30%) admitted ingesting illegal sexual-enhancement drugs before the onset of hypoglycemia. Drug samples obtained from these patients and from drugs seized in police raids were analyzed by means of high-performance liquid chromatography. Four preparations were contaminated with glyburide in amounts ranging from 13 to 100 mg per tablet (Figure 1A). These drugs included a counterfeit of Cialis (tadalafil) and three herbal preparations for the purported treatment of erectile dysfunction (Power 1 Walnut, Santi Bovine Penis Erecting Capsule, and Zhong Hua Niu Bian).3 All four products also contained sildenafil in amounts ranging from 0.5 to 110.0 mg per tablet. Santi Bovine Penis Erecting Capsule and Zhong Hua Niu Bian also contained trace amounts of tadalafil and sibutramine.

Translation: Travellers in foreign climes be warned. The Cialis and crap Chinese copies/clones/competition you buy off the street in towns like Bangkok are pirated and could possibly contaminated by substances like glyoburil which is a diabetes drug that is harmful to non-diabetics. In Singapore, in a three month period in 2008, nearly 200 people were admitted to hosptial and four people died from these sprurious medications. There was a similar though more restricted experience in Hong Kong at around the same time. The NEJM article does not say where these medicines were purchased.

"Zhong Hua Niu Bian" means Chinese Bull Penis. "Saint Bovine" also hints at the non-herbal origin of the source of these pseudo-TCM's "Penis Erecting" power. [This just screams for a 'Truth In Naming' case-study.]

Of course, eating the (herbal) penis of any dead animal is a total waste of time in a pharmacological sense: a) they're really chewy, b) just don't. The TCM idea of like for like is patently illogical nonsense to my Western eye. Eat a big penis get a big penis? What a - dare I say it - wank.

Penis munchers, you might HYPNOTIZE yourself into a placebo effect, but note that these "herbal" products are also stuffed with various amounts of tadalafil (Cialis) and sildenafil (Viagra) which DO actually work in many cases of ED. So if some of these herbal remedies eventually work, it's because they are packed surreptitiously with the REAL medicine, not because of the TCM's magic properties!

But note too the potential dose range across the products seized: "All four products also contained sildenafil in amounts ranging from 0.5 to 110.0 mg per tablet." At least if you buy the genuine article you know that the dosage is going to be close to that stated on the package, and the results can be assessed in a reasonable light.

With any herbal concoction, not only are the doses basically random due to the typical slack QA at these snake-oil producers factories , there is also a higher risk of contaminants, such as occurred with the glyburide.

Of course these products were probably stamped together in a filthy backyard factory in Outer Nowheresville, China, perhaps near a slaughterhouse for a steady supply of bull products. They could contain anything, and usually do. The milk scandal is another case of un-policed Chinese regulations allowing producers to get away with, literally, murder.

If you would consider buying such drugs off the street you should first get a mirror and some Viagra eyedrops - then take a long, hard look at yourself.

E@L