Online sexual enhancement products risky: FDA

Some sexual enhancement products sold on the Internet contain the same ingredients as prescription drugs such as Viagra and are not only illegal but also dangerous, the U.S. Food and Drug Administration cautioned on Wednesday.

Erectile dysfunction products can cause a deadly interaction with many heart drugs, notably those containing nitrates."The U.S. Food and Drug Administration is warning consumers not to purchase or consume Zimaxx, Libidus, Neophase, Nasutra, Vigor-25, Actra-Rx, or 4EVERON," the agency said in a statement."These products threaten the public health because they contain undeclared chemicals that are similar or identical to the active ingredients used in several FDA-approved prescription drug products," added Dr. Steven Galson, Director of the FDA's Center for Drug Evaluation and Research.

"This risk is even more serious because consumers may not know that these ingredients can interact with medications and dangerously lower their blood pressure."

Zimaxx contains sildenafil, the active pharmaceutical ingredient in Viagra, Pfizer's prescription erectile dysfunction product.The other products contain chemical ingredients that are similar either to sildenafil or to vardenafil, the active ingredient in Levitra. Levitra is a prescription erectile dysfunction drug developed and sold jointly by Bayer AG, GlaxoSmithKline Plc and Schering-Plough Corp.."Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates," the FDA said."ED (erectile dysfunction) is a common problem in men with these conditions, and they may seek products like the ones noted above because these products claim that they are 'all natural' or that they do not contain the active ingredients used in FDA-approved ED drugs."

The agency said it had stopped a shipment of 4EVERON from entry to the United States and warned the companies selling the drugs.

Amsterdam clinic offers gamers path back to reality

Addiction expert Keith Bakker hopes the serenity of a 16th century townhouse on one of Amsterdam's canals will coax those snared in the fantasy world of online games back to reality.

The townhouse, where sunlight warms the honey-colored wood of the centuries-old floors, houses Europe's first clinic for people hooked on playing online games.It is run by addiction consultants Smith & Jones, who felt there was a need for treatment even though experts are still debating whether excessive game playing is an addiction."We started seeing it about two years ago, people started coming in with gaming as sort of a secondary problem," Smith & Jones director Bakker, 45, said.

"Then, we got one kid in who was gaming 18 hours a day and I wanted to send him somewhere and we looked around and there was nothing, so we started looking into it," said Bakker, who struggled himself with drugs and alcohol in the past.

Smith & Jones began offering day programs to help gamers, both those playing online and those hooked on video games."There are groups, however, that don't easily change or those that come in for a day program and will tell you all the wonderful things you want to hear and go home and are online again," Bakker said.Smith & Jones now offers in-patient programs for a dozen people at a time, lasting four to six weeks.Those checking in have often put their lives -- school, work, friends, personal hygiene -- on hold to keep playing, using anything from Red Bull to cocaine to stay alert.Tim, 21, who has not played for a month since doing the day program, said he hardly left his room for five years, gaining weight and using drugs.

Like many others he started out with a handheld GameBoy aged 12 but progressed to multiplayer online games that offer open-ended stories set in virtual universes that can support tens of thousands of players.

I couldn't go to the toilet because then I would have to leave ... I would take an empty bottle and pee in it."Games offered an escape from bullies at school, he said. He only sought help after his mother threatened to throw him out.KEEPING CHILDREN QUIETSometimes, parents are partly to blame for their children's behavior, said Bakker, who was born in the United States."Often there are parents who are happy that the kid is on a game, at least it is quiet and off the streets," Bakker said."Or, they'll say 'why don't you go play, while mom and dad talk'."The pull of games such as World of Warcraft, the sword and sorcery game EverQuest, racing game Gran Turismo or the 2006 FIFA World Cup game translates into a billion dollar industry.The worldwide online games market is expected to grow to $13 billion by 2011 from $3.4 billion in 2005, according to market research firm DCF Intelligence.Some 114 million people are expected to be playing online games by the end of 2006, the firm predicts.Research suggests online game playing may trigger the release of the chemical dopamine in the brain. A study done in London's Hammersmith Hospital showed that increased levels of dopamine were roughly the equivalent of a dose of speed, an amphetamine that can be addictive.Countries like South Korea and China, which boast the largest online games communities, are working with game operators on systems to discourage compulsive behavior.A 28-year-old South Korean died of heart failure last year after playing a game called "StarCraft" for 50 hours at an Internet cafe. The parents of a 13-year-old Chinese boy who killed himself after playing a computer game for 36 hours are suing the game's licensed Chinese distributor.BE A SUPERHERO"Gaming is the greatest danger to young people that has ever come along," said Bakker.Like many addicts, he said, gamers are often trying to escape personal problems or just the difficulty of growing up."The reality of being a 14, 15-year-old kid is not fun, it's puberty and puberty is tough," he said. "And there are moments now where all you have to do is push a button and you're a superhero ... there's a very enticing part about games."The treatment offered by Bakker's firm is similar to that used to fight gambling or alcoholism. However, with gaming, the tricky part is the computer, which can hardly be avoided."Gamers cannot simply abstain from using computers, they are now an integral part of our lives," Maressa Hecht Orzack, founder of a computer addiction service at McLean Hospital in Boston, told New Scientist magazine."They must learn to normalize their computer use just as those with an eating disorder need to learn to eat in order to survive," Orzack, a clinical psychologist, said.Treatment for excessive game playing is not covered by health care insurance, so patients have to cover the cost themselves - 500 euros ($640) a day.After the treatment, patients must come to terms with an uncomfortable truth: their addiction will always be there.Bakker calls it the terrorist inside.

"It can't blow me up, but it tells me one drink, one game of warcraft is OK ... but you need to fight it every day."