June 5, 2001 (Anaheim, Calif.) — The role male hormones, such as , play in male sexual desire has long been acknowledged. But new research presented here at the annual meeting of the American Urological Association shows that these hormones, collectively known as androgens, are involved in much more than simple desire — they are also vital for sexual arousal and sexual performance.

And not only in men.

“Androgens have a very central role in sexual function for both males and females,” says Irwin Goldstein, MD, professor of urology at Boston University School of Medicine. “Physicians have studied androgens in men and estrogens in women, but we have never crossed the bridge and studied androgens in women.”

Women with insufficient androgen — which can be caused by taking birth control pills or antidepressants, pregnancy, or stress, among other things — not only have low levels of desire, they also have reduced feelings or arousal and muted, less enjoyable orgasms, according to Goldstein.

“There is clear and obvious need for research on the role of androgen in the three phases of the sexual response cycle: desire, arousal, and orgasm,” he says. “The original concept of pure desire is oversimplified.”

At the meeting, Goldstein presented findings from a study showing that women with sexual problems related to low levels of androgen could be successfully treated with (DHEA) — an androgen hormone — without significant side effects.

But Goldstein strongly cautions women about using DHEA, which is sold commercially over the counter, without first consulting a physician, a warning echoed by other urologists at the meeting.

“While we have this new information — and the results are phenomenal — women cannot just go and use this,” Goldstein says. “This is a drug, and it can have side effects that we do not yet totally understand.”

Among the problems that may be associated with DHEA use are cancer, ambiguous genitalia in offspring, acne, hair loss, and weight gain. These potential problems lead Ira Sharlip, MD, president of the Sexual Medicine Society of North America, to recommend that the sale of DHEA be regulated.

In Goldstein’s study, 32 women with low androgen levels received daily DHEA for an average of five months. The treatment seemed to increase their levels of androgens, while improving their self-evaluations of sexual performance.

The most commonly reported changes in sexual function while on DHEA were marked increase in sexual spontaneity, decreased time needed to achieve arousal, a return of sexual fantasies, and an increase in the duration of sexual arousal, according to the report.

Another study presented at the American Urological Association meeting examined male-female couples who came to a male sexual dysfunction clinic. The researchers found that many of the women — who accompanied their male partners for treatment — had problems of their own.

In the study, presented by Juza Chen, MD, of Tel-Aviv Sourasky Medical Center in Israel, 113 women were asked about their own sexual dysfunction in a series of questionnaires. The results showed that more than half reported at least one sexual dysfunction, and that in 90% of the couples the woman had initiated the clinic visit.

Almost two-thirds of the women had problems with orgasm, more than half had decreased sexual desire, and more than one-third had sexual arousal disorder, according to the report.

So what kind of doctor should women seek out when suffering from sexual problems?

Goldstein suggests they talk to a physician with a special of sexual problems. And he predicts the emergence of a new category of physicians who will be specialists in sexual medicine.

“My dream is that there will be a class of doctor called a sexual medicine physician,” Goldstein says. “And doctors who are sexual medicine experts will have to take on the female world. The traditional provider in women’s health is the gynecologist, but there has been little research going on in gynecology in this area.”

More women are seeking help for sexual problems, Goldstein says, and the days of don’t ask, don’t tell may well be numbered.

He attributed the change to the introduction of Viagra, the first drug treatment for sexual dysfunction in men.

“This is the beginning of an era,” he says. “In 1998, when Viagra came out it empowered women to seek help for their own sexual dysfunction.”

Pre-Viagra, Goldstein says, people with sexual problems were dependent on prosthetic devices, or on drugs that were injected into the genitals. “These are not for women,” he points out.

And Goldstein stresses that sexual problems are similarly painful for both genders.

“It is an ego-deflating, frustrating, embarrassing, humiliating problem,” he says. “It is not a male-only or a female-only thing. And the quality of life is markedly improved with treatment.”

May 18, 2001 — What’s blue, comes in bottles, costs a hefty chunk of change per dose and is reputed to enhance sexual performance? If you said Viagra, you’re close but no cigar. The stuff in question is an herbal beverage called Niagara (nudge, nudge, wink, wink), made in Sweden and billed by its U.S. distributor as “Romance in a bottle.”

The distributor, Lari Williams, who describes herself as “just a little girl from Arkansas trying to bring romance back to the bedroom” is doing it with the help of Nerve, a magazine that unabashedly peddles itself as “more graphic, forthright, and topical than ‘erotica,’ but less blockheadedly masculine than ‘pornography,’” according to the company’s mission statement. In other words, Nerve aims for a demographic somewhere between Reader’s Digest and Hustler.

Niagara is a blue-dyed concoction containing carbonated water and sugar spiked with the alleged herbal aphrodisiac damiana (reputed to be a plant estrogen), plus ginseng (a root commonly used in Chinese medicine), guarana (a stimulant similar to caffeine), mat (another stimulant), schizandra (a Chinese medicinal said to have aphrodisiac and stimulant properties), plus as much caffeine as an eight ounce cup of coffee.

Williams tells WebMD that she discovered Niagara at a food and gifts trade show in Dallas last January. “I tried it one night and realized that it definitely had an effect on me, and I told my husband ‘I’m buying 3,000 bottles’ because it was close to Day, and he was going ‘Oh my gosh, no you’re not,’ and I went ‘Yes I am’ and he was just about to kill me. Well, we sold 15,000 bottles in two days. We had to make two trips to Dallas to go pick up more product.”

Williams, owner of a gourmet coffee and food shop in Little Rock, adds that “here in Arkansas we have what we call ‘Niagara Nights.’ People get their six-pack or two or three bottles and walk out the door high-fiving each other going ‘Ooh, we’re having a Niagara night tonight!’”

One of William’s customers, a 45-year-old saleswomen, told Arkansas Times in March that “I usually wear down … I was hanging in there. I was proud of myself … It lights your fire.” Another said, “It made me feel really warm, really sensual, … much more sensitive.”

Testimonials are one thing, but proof is another. Because the combination of ingredients in Niagara has never been subjected to scientific scrutiny, it’s difficult to know whether Niagara actually stimulates the female libido.

“The problem with a lot of these aphrodisiacs — and it’s a problem with the whole herbal industry — is the fact that there’s no validation of the product and it’s not under any kind of FDA control,” says Eloy Rodriguez, PhD, professor of plant biology at Cornell University in Ithaca, N.Y.

Rodriguez tells WebMD that he previously investigated damiana (which Williams says is the main active ingredient in Niagara), but found no biochemical evidence that it had sexual stimulatory properties. In the book A Modern Herbal, published in 1931 and revised in 1971, Mrs. M. Grieve described damiana as “a mild purgative, diuretic, tonic, acting directly on the reproductive organs, stimulant … aphrodisiae.”

If the claims about Niagara’s effects are unproven, what’s certain is that a lot of people are excited about the product, including Williams, who saw sales skyrocket after her web site was featured on a segment of ABC’s Good Morning America. The Playboy mansion recently ordered more than 1,400 bottles of Niagara, and it’s being hawked on the Internet auction site eBay for $50 per bottle and up (it retails for $29.95 a six pack) says Alisa Volkman, a spokeswoman for Nerve.com. Niagara has popped up on NBC’s Today Show, ABC’s chatfest The View, and the Montel Williams show.

The folks at Nerve and its online incarnation are in ecstasy as well: after they “broke” the Niagara story on their Web site in March, they agreed to develop a Web site for Williams to push the product. They have also just nailed down a film development deal with Revolution Studios, which has acquired the rights to the story for a production company partly owned by Julia Roberts and Adam Sandler, with a script being developed for Sandler, says Volkman, who is also vice president for film development at Nerve.

The folks at Pfizer, manufacturer of Viagra, are pretty worked up about Niagara too. They took Williams to court for trademark , but failed to get a temporary order. In his decision the Arkansas judge was quoted as saying “if men can have Viagra then women should be able to have Niagara.”

For the moment at least, women have their Niagara. Williams assures WebMD that neither she nor anyone connected with the beverage makes medical claims for it, which would be a violation of FDA regulations. In 1989, the FDA issued a statement that there is no scientific proof that any over-the-counter aphrodisiacs work to treat sexual dysfunction, and the agency has issued recall requests of some products with aphrodisiac claims.

“I can only tell people that they must be smart and realize when somebody tells them ‘this is so-and-so,’ they have to rely on the fact that the person knows what they are talking about,” Rodriguez says. “Most of the time, they’re just carnival barkers that got fired.”

Dec. 20, 2001 — Thanks to Viagra, millions of men now have a new lease on their sex lives. Alas, millions of women still aren’t in the mood.

Studies suggest that almost half of women in the U.S. suffer from some type of sexual dysfunction, with low libido (or sex drive) at the top of list. Their therapeutic options are few, but that may soon change thanks to a growing number of researchers studying female sexual complaints.

In the past, women seeking medical help for sexual problems were likely to be told that it was all in their heads or that they needed to relax. But the perception that female sexual dysfunction is wholly psychological has changed.

Early last year, a classification system for female sexual dysfunction was adopted which includes four diagnostic categories — hypoactive sexual desire, or low libido; sexual arousal disorder; orgasmic disorder; and sexual pain disorder.

“The categories will help define research, but there is still a lot of overlap between them,” sex researcher and therapist Laura Berman, PhD, tells WebMD. “Most women seek help for low libido, but the truth is there could be all kinds of things going on that cause her to feel she has no interest in sex.”

Berman co-founded the Female Sexual Medicine Center at the UCLA Medical Center with her sister Jennifer Berman, MD, who is a urologist. The sisters are among the leading researchers of female sexual issues and recently published a book on the subject titled For Women Only: A Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life.

Berman says low sex drive may stem from emotional issues, issues, inability to reach orgasm, decreased vaginal and clitoral sensitivity, lack of lubrication, hormonal imbalance, or a host of other issues. Many women lose interest in sex or lose the ability to become aroused at the onset of menopause, and also experience sexual problems following hysterectomy and other pelvic surgeries.

At present, the only approved treatment for female sexual dysfunction is a sexual aide marketed under the name Eros-CTD. The handheld device provides suction to the clitoris and promotes engorgement and lubrication.

Studies evaluating the of Viagra in women have been contradictory, but Berman says a widely publicized study finding it to be ineffective was poorly designed.

“Viagra definitely has a role for a certain population of women, namely those who experienced satisfying sexual response at one time but lost that satisfaction due to physiologic reasons,” she says. “They feel good enough about themselves and their bodies and the person they are with, but they still have difficulty becoming aroused.”

Although not approved for female sexual dysfunction, the hormone testosterone is increasingly being prescribed in both its oral form and as a topical cream. Testosterone is the hormone that makes men men But women have the hormone, too, in smaller amounts. Increasing testosterone levels is tricky, Berman says, because there is no clear consensus on what constitutes low testosterone in women. Topical nitroglycerin creams are also being studied in women who experience pain during sex.

The UCLA are researching a topical cream called Femprox, which has been shown to increase blood flow to the genital area. Inadequate blood flow results in vaginal dryness and difficulty becoming aroused.

Berman says women who have difficulty achieving orgasm can be the most difficult to treat because little is known about the disorder. The problem might stem from either a physiological or emotional problem.

“The bottom line is that for every woman there are emotional, relationship, and medical factors contributing to their sexual problem, but to differing degrees,” she says. “The goal is really identifying all of the causal factors and attending to them in a comprehensive way.”

May 3, 2000 (Washington) — Many women may have yet another reason to rejoice. The FDA said Wednesday that it has approved UroMetrics Inc.’s Eros-CTD, the first treatment for female sexual dysfunction. The announcement follows recent reports from a urology meeting, indicating that the blockbuster male impotence drug Viagra also may perhaps offer some measure of sexual for women.

But unlike Viagra, for which physicians already are offering some , the Eros Clitoral Therapy Device has no potential side effects. In fact, the FDA approved the device under less stringent requirements than those usually applied to novel devices, because there were no side effects reported in the supporting study or any side effects suspected by the FDA reviewers, Sharon Stone, a FDA spokeswoman, tells WebMD.

The device is a small, soft, plastic cup that with a battery-operated pump increases blood flow to the vaginal area.

The approval was based upon a single study of 25 women, including 15 who had sexual dysfunction and 10 who did not; the 25 women used the device at home during six sexual encounters. The study tested for sensation, ability to achieve orgasm, sexual satisfaction, and lubrication.

According to the FDA analysis, all 15 women with sexual dysfunction experienced more sensation. Of those 15 women, seven also experienced more orgasms, 12 had more satisfaction, and 11 experienced more lubrication. The 10 women with normal sexual function all experienced more sensation; four also had more orgasms, two had more satisfaction, and three had more lubrication.

The concept also has been applied in males, says Irwin Goldstein, MD, professor of urology at Boston University School of Medicine and one of the investigators. But further data are needed to determine its overall value for women, including whether increased blood flow makes a difference and how much vaginal lubrication actually is achieved, he tells WebMD.

In the meantime, Goldstein says, the class of patients most likely to benefit from this device appears to be women with sexual dysfunction who are interested in sex but unable to have orgasm. Pre-menopausal women with normal sexual functions are unlikely to see much of an advantage, he adds.

The device does appear to work much like Viagra, suggesting that it should have perhaps a similar effect, Ira Sharlip, MD, a urologist and partner at Pan Pacific Urology in San Francisco, tells WebMD. Viagra also appears to increase vaginal blood flow. Taken in context, Eros represents another treatment option, Sharlip says. But that is not to say that Eros is for everyone, he adds. Some men are highly resistant to using the penile pump used for impotence, and it is likely that some women also may find the concept disturbing. “I would leave it up to the patient’s discretion,” he tells WebMD.

Women with sexual dysfunction who would like to give it a try will be able to get one , UroMetrics’ spokeswoman Marlene Wesen tells WebMD. The prescription device is already available in Australia, France, and United Kingdom and will be sold in the U.S. for $359, she says.

June 5, 2001 (Washington) — ArginMax — a dietary cocktail consisting of ginseng, ginkgo, B vitamins, calcium, folic acid, and other vitamins and minerals — is being heralded as one component of a lifestyle that improves sexual and helps prevent problems associated with intimacy.

Instead of focusing just on disease, backers of this holistic approach want to work on a person’s behavior, including such things as diet, exercise, and stress management skills. Making these behavioral changes over a 30-day period, in conjunction with taking the supplement, can significantly boost sexual performance, says Hank Wuh, MD, MPH, director of Nascent Pharmaceuticals and the Daily Wellness Company, the company that makes ArginMax.

“It’s like the change in thinking about heart disease over the last 30 years, which is now much more focused on prevention,” says Wuh. “This is not about dysfunction. It’s about optimizing your sexual health.”

Steve Greenfield, a fire department captain in San Jose, Calif., is sold on the philosophy. Now in his 50s, Greenfield has been taking ArginMax for three years.

“The result is that every aspect of my life has been enhanced, both physically and mentally — and even sexually,” Greenfield said at a news conference Tuesday.

However, one of the remaining questions about dietary supplements is that they haven’t been scientifically investigated. Now, new research on ArginMax indicates the product is effective in women who complain of sexual dysfunction. The study, done by Mary Lake Polan, MD, PhD, who heads the department of gynecology and obstetrics at Stanford University School of Medicine, compared women who took the supplement to those who were given a look-alike placebo pill.

The 93 women, aged 22 to 73 years, were evaluated after one month. The results, Polan says, were that the women taking the active supplement reported more than twice the level of sexual activity and satisfaction than the women taking the placebo.

“Frequency of intercourse increased, frequency of sexual desire, level of sexual desire, satisfaction, satisfaction with overall sex life, in a statistically significant fashion,” says Polan, whose study was in part by ArginMax.

The finding is a real boost for women, she says, since there is virtually no Viagra-like therapy for them. (Studies looking at using Viagra in women have come up with mixed results.) The results are published in the May issue of the Journal of Women’s Health and Medicine.

It not clear how the supplement, which consists of 14 minerals and vitamins, works. But Polan believes it may enhance vaginal blood flow by stimulating a forerunner of the chemical nitric oxide, which dilates blood vessels.

On the other hand, Viagra simply prevents the breakdown of nitric oxide. That may explain why studies of the drug in women have shown only modest success.

Unlike Viagra, Polan says, ArginMax has no side effects. It may also work on certain nerve pathways in women that help generate arousal. Research on men, says Polan, shows their sexual responses are much more linear and rapid than in women.

Hendy Lund, one of the participants in Polan’s study, says she completely lost her sex drive at age 29, even though there were no problems between her and her husband.

“It ArginMax works, that’s the bottom line for me. It brought me back to being normal, and that’s vitally important for me,” says Lund.

Over time, millions of women may be facing similar problems as the baby boomers head into middle and old age.

“Why shouldn’t there be a nutritional supplement that’s really researched and designed primary for the area of sexual health?” asks Wuh.

Richard Balon, MD, professor of psychiatry at Wayne State University in Detroit, has some concerns that the supplement isn’t regulated as stringently as a drug. However, he concedes it may work for some who have sexual problems.

“It’s a big problem, and I wouldn’t throw their supplement out. Why would I do that? We know that it’s an otherwise innocuous thing which helps somebody feel better, and helps them with sex,” Balon tells WebMD.

July 26, 2000 –Until last week, Jennifer Erickson was just an ordinary pharmacist, working at a drugstore in Seattle. Now, the 26-year-old married woman is the poster girl for women everywhere who have had to plunk down their own money to pay for birth control.

On July 19, Erickson, who says she would like to have children some day but is not ready yet, filed suit against her employer, Bartell Drug Co., charging them with sex discrimination for paying for other prescription drugs, but not prescription birth control. Erickson is one of approximately 42 million women in this country who use birth control. Although she has a good job and can afford the more than $300 per year that her prescription birth control pills cost, she doesn’t think she and millions of others should have to pay for them. And neither do plenty of medical and health policy experts.

“Contraception is a fundamental part of health care, just like vaccinations,” says David A. Grimes, MD. “It’s good, cost-effective, preventive health care.”

Grimes is of medical affairs at Family Health International, a nonprofit group in Research Triangle Park, N.C., that helps men and women get access to family-planning services and methods. He says that from a corporate viewpoint, contraception makes sound economic sense. By averting a birth, the company saves money, especially if that birth is premature or there are other complications, he tells WebMD.

Approximately half of all large group insurance plans will not pay for any form of prescription birth control. Only about a third of policies include oral contraceptives in their prescription drug coverage. Most HMOs do cover the Pill, but only about 40% cover the other four FDA-approved contraceptive options: IUDs, diaphragms, Depo-Provera shots, and Norplant implants.

“As women, we’ve been excluded from so much,” says Karen Rashke, staff attorney for the Center for Reproductive Law and Policy. “We’ve just sort of taken it in stride. I don’t think a lot of us thought much about this until recently.”

Although plenty of women have complained for years about being refused coverage for what many see as a basic health need, until the Erickson lawsuit was filed last week, no single person had ever stood up to an employer and demanded that they pay. Erickson’s lawsuit seeks birth control coverage for herself and all other non-union female employees of Bartell Drug Co., which has more than 45 pharmacies in the state of Washington.

In a statement to the media, representatives of Bartell Drug Co. said they believe their insurance plan is “lawful and nondiscriminatory.” They point out that they do not pay for Viagra, infertility drugs, drugs for weight reduction, immunization agents, drugs for cosmetic purposes, and various other items.

Roberta Riley of Planned Parenthood of Western Washington, who is the lead attorney in Erickson’s, case, says her client repeatedly asked her employer to change its policy and cover birth control. When they continued to refuse, she decided to sue.

“I think it was only a matter of time before something like this happened,” says Cynthia Dailard, senior public policy associate at the Alan Guttmacher Institute in Washington, D.C. “If the lawsuit is successful, it will put many employers on notice that they could face similar lawsuits if they do not cover contraceptives, and that it is a matter of gender discrimination.”

Both Planned Parenthood of Western Washington and Planned Parenthood Federation of America, which is also representing Erickson, say birth control prevents unintended pregnancies and reduces the need for abortion.The group cites 1998 statistics showing that nearly half of all pregnancies in the U.S. are unintended, and many of these pregnancies end in abortion.

Experts who spoke to WebMD agree that one thing that has increased women’s anger over this lack of coverage is the advent of Viagra.

“Viagra is covered by many insurance programs and was scooted onto the market so quickly, while women have been struggling for decades to get coverage of contraception,” Grimes says. He believes the discrepancy amounts to nothing less than discrimination against women, many of whom cannot afford $20-$30 per month for birth control pills.

It is estimated that women of childbearing age pay about 68% more out of their own pockets for medical expenses than men. And now, even the Viagra pills — at $10 apiece — are often covered, while birth control is not. According to estimates, paying for birth control would cost insurers only about $1.43 per month for each female employee. That would provide them with all available FDA-approved forms of contraception; the cost would be even less if the employer only provided coverage for some methods.

Some in Congress are trying to force change by passing a law that would require all employers and insurance companies to pay for birth control. Progress has been slow, but individual states have passed such laws on their own. States that require companies who pay for other prescription drugs to pay for prescription birth control include Maryland, Georgia, Vermont, Maine, Nevada, Connecticut, North Carolina, Hawaii, New Hampshire, California, Iowa, Delaware, and Rhode Island. But nine of the 13 states have provisions that let employers, enrollees, or insurers who object to such coverage on “religious grounds” off the hook.

Most experts say individual states will probably continue to pass laws, and people will keep a close eye on the progress of Jennifer Erickson’s lawsuit. But what can a woman who is paying for her own birth control do in the meantime?

“Employees have the ability and the right to speak to their benefits manager,” attorney Rashke says. “There’s no reason an employee can’t go to the benefits manager and say, ‘I notice in my prescription coverage there’s an exclusion for contraception.’ That’s the first step.” If you don’t want to do it on your own, Rashke advises talking to other women you work with to see if they will take the concerns to the benefits manager as a group.

“One person can do a lot by raising the issue at cocktail parties, writing a letter to the editor … just point out this lack of coverage that so many of us haven’t even thought about,” she says.

June 24, 2005 — Viagra and other erectile dysfunction drugs won’t be
covered when Medicare launches its prescription drug benefit in January,
according to a spending bill passed in the House of Representatives Friday.

Lawmakers voted to bar Medicare or Medicaid from paying for the drugs as
part of a bill funding federal health and education programs. The amendment,
which passed 285-121, comes several weeks after reports that several state
health programs were funding the drugs for prisoners, including convicted sex
offenders.

Rep. Steven King (R-Iowa) — a sponsor of the amendment — said that without
the prohibition Medicare would wind up providing “taxpayer-funded
recreational sex drugs.” The ban includes Viagra and two similar drugs,
Cialis and Levitra.

Some opponents argued that the drugs are important treatments for men who
lose sexual functioning because of illnesses including diabetes and nerve
damage. “It’s important that these drugs are available when they’re
medically necessary,” said Rep. Nancy Johnson (R-Conn.), who chairs the
Ways and Means health .

But that argument was rejected by supporters of the ban, some of whom
stressed that federal funds should not be spent on sexual enhancement
drugs.

“Sex is never medically necessary. If it was, priests wouldn’t live into
their 90s,” King tells WebMD.

The amendment is not the final word on the drugs. The Senate has yet to
weigh in on its own version of the health and education funding bill, and
manufacturers are almost sure to use their powerful lobbying
forces to oppose the ban in the final version of the bill.

It’s probably not the last word on the topic,” Rep. Ralph Regula
(R-Ohio), chair of the appropriations subcommittee on health, education, and
labor, tells WebMD. Regula supported the ban.

Senate Finance Committee chair Charles E. Grassley (R-Iowa) last month
introduced legislation that would eliminate federal funding for Viagra, Cialis,
and Levitra. Medicare and Medicaid would spend $2 billion on the drugs over the
next decade if they remained eligible for federal funds, according to a
statement released by Grassley’s office.

“We live in a world of limited resources, and those dollars could be
spent more wisely,” Grassley said.

Some Cuts in Spending Bill

The amendment overshadowed the overall spending bill, which grants $63
billion on federal health programs but includes cuts to several major agencies.
Rep. David Obey (Wis.), the senior Democrat on the House
Committee, expressed frustration that debate about Viagra had, at least
temporarily, taken precedence over “what is happening to sick people with
this bill.”

The CDC faces a $295 million cut to its budget, though the nearly 5% in
reductions was less than President Bush had asked for in his budget.

The bill also sends $28.4 billion for research at the National Institutes of
Health, a 0.5% increase after five years in which its budget was doubled by
Congress. Lawmakers also voted to cut $100 million from the U.S. contribution
to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to cut 84%
from a program providing medical training grants to future doctors and
nurses.

A $1.8 billion program favored by President Bush to build new community
health centers to serve uninsured people got a $100 million boost over last
year. But another White House-backed program to fund new electronic health
records technology received $3 billion less than the $78 billion Bush had
requested.

Meanwhile, the bill gave a more than 10% increase to sex
education programs, which remain controversial over questions of their
effectiveness in delaying or preventing teens’ sexual activity. The federal
government would spend $115 million on the programs next year under the
bill.

Lawmakers voted 250-151 to pass the spending bill, which faced criticism
from some Democrats who said tax cuts favored by Republicans prevented spending
on key health programs.

“This is the most important bill that we will consider this year in
terms of meeting the needs of the average American family. This bill just
doesn’t measure up to our national obligations,” Obey says.

“When we have less money, we spend less money,” Rep. Joel Hefley
(R-Colo.) tells WebMD.