Monday, January 14, 2019

Syövän hoito Suomessa: hyvää vai huonoa? Osa 2: kustannukset, tutkimukset ja yhteenveto



Syövän hoidon kustannukset ovat nousussa, mutta taudin vuoksi menetetty tuottavuus on nelinkertainen summa. Vain muutama prosentti suomalaisista syöpäpotilaista pystyy osallistumaan kliinisiin tutkimuksiin, joiden kautta olisi saatavissa uusin hoito

Ensimmäinen osa julkaistiin 8.1.2019

Hoidon kustannukset

Syövän kokonaiskustannusten laskeminen ei ole kovinkaan yksinkertaista. Missään tapauksessa ei voi laskea pelkkää lääkekustannusta jostakin vanhemmasta sytostaatista, verrattuna johonkin uudempaan lääkkeeseen, joka aiheuttaa vähemmän haittoja. Merkittävä osuus sytostaatteja saavista potilaista saa sairaalahoitoa vaativan komplikaation. Lisäksi sytostaattien annostelu vaatii huomattavan määrän hoitohenkilöstön työtä, verrattuna esimerkiksi suun kautta annosteltaviin lääkkeisiin.

Laskelma monimutkaistuu, kun mukaan otetaan sairaslomat, taksilla ajelu ja hoitojen tai kuolemien aiheuttama vähentyminen veronmaksukyvyssä. Yhtälö menee mahdottomaksi laskea, jos yritettäisiin huomioida parantavien hoitojen vaikutus. Vaikka parantava hoito olisi lääkekustannuksiltaan huomattavan kallis, se kannattaisi silti ehkä antaa mahdollisimman aikaisin, jotta muilta hoitokustannuksilta vältyttäisiin, ja potilas saataisiin takaisin töihin maksamaan veroja.

On arvioitu, että syövän globaalit hoitokustannukset ovat noin 300 miljardia euroa vuonna 2017, joista vajaat puolet on lääkekustannuksia. Loput ovat pääosin henkilöstö-, tila- ja materiaalikuluja, joista valtaosa liittyy sairaalahoitoon (IQVIA, Mariotto et al). Syövän vuoksi menetetty tuottavuus on kuitenkin jopa nelinkertainen summa (Allemani et al, Knaul et al, WHO), vastaten 2 prosenttia globaalista bruttokansantuotteesta. Vaikka syöpä aiheuttaa noin neljänneksen kuolemista, ja osuus on kasvussa, sen osuus terveydenhuollon menoista EU:ssa on vain 6 prosenttia (Voda). 

Suomessa syövän hoitoon kuluu 4,4 prosenttia terveydenhuollon menoista – osuus on Euroopan pienimpiä (Jönsson). Tämä tuntuisi puoltavan lisäsatsausta diagnostiikkaan ja hoitoihin, eikä hoidon kalleutta voi pitää kansantaloudellisesti kestävänä perusteluna potentiaalisesti parantavan hoidon epäämiselle.

Lisäksi ovat toki humanistiset arvot, jotka ovat lääketieteen lähtökohta, mutta joita harvoin huomioidaan teknokraattisissa laskelmissa.

Kun syöpää ei voi parantaa rutiinimenetelmillä

Levinneiden kiinteiden kasvaimien, eli muiden kuin veren syöpien, hoitomuodot ovat viime vuosiin asti olleet yleensä parhaimmillaan elinaikaa pidentäviä, eivät parantavia. Näin ollen lähes jokainen potilas on jossakin vaiheessa ollut tilanteessa, jossa tauti etenee käytetyistä rutiinihoidoista huolimatta. Oma mielipiteeni on, että jokaisen potilaan pitäisi saada harkita kokeellisia hoitoja tässä tilanteessa. Kokeellinen hoito tarkoittaa lääketieteeseen perustuvaa hoitoa, josta ei ole yhtä laajoja kokemuksia kuin rutiinihoidoista.

Kokeellisiin hoitoihin on kaksi reittiä. Toinen on yksilöllinen hoitokokeilu, jonka ainoa tarkoitus on potilaan auttaminen. Ihmiskunta ei tällaisista kokeiluista juurikaan hyödy. Hoitopaikasta riippuen maksaja on potilaan kunta, vakuutusyhtiö tai potilas itse.

Lääketieteen kehittymisen mekanismi on kliiniset tutkimukset. Näissä hoito on yleensä ilmainen, mutta hoidon päätarkoitus on eri. Tutkimusten tavoitteena on lisätä lääketieteellistä informaatiota. Potilas voi hyötyä tai olla hyötymättä, ja haittoja voi tulla hyödyistä riippumatta. Ihmiskunnan kannalta paras tilanne olisi, jos kliinisiä tutkimuksia olisi tarjolla kaikille potilaille jotka ovat niihin suostuvaisia.

Kliiniset tutkimukset

Moni potilas ajattelee, että jos hän on valmis koekaniiniksi, niin totta kai kliinisiä tutkimuksia löytyy, kun kerran lääketiede kehittyy niin kovaa vauhtia. Saammehan joka päivä lukea mediasta jostakin mullistavasta hiirikokeesta. Käytännössä kuitenkin vain pieni osa potilaista, jotka haluaisivat osallistua kliiniseen tutkimukseen, pääsevät mukaan.

Asiasta on paljon kirjallisuutta, ja yleisesti arvioidaan että yli puolet potilaista haluaisi osallistua kliinisiin tutkimuksiin, mutta alle 5 prosenttia pääsee todellisuudessa osallistumaan. Vain yksi kymmenestä halukkaasta pääsee siis mukaan tutkimuksiin. Erityisesti kliiniset lääketutkimukset ovat globaali ala. Sponsorit, jotka ovat yleensä lääkefirmoja, tekevät tutkimuksia niissä maissa, missä sairaaloissa on hyvät ja tunnetut tutkimusyksiköt, ja joissa on yhteistyöhaluiset viranomaiset. Valitettavasti Suomi ei pärjää kummallakaan mittarilla. Tämä näkyy selvimmin siinä, että vain muutamalle prosentille yliopistosairaaloiden potilaista löytyy kliinisiä tutkimuksia (Iltalehden artikkeli, Hemminki A).

Tuoreessa Lääkärilehden jutussa kerrotaan että TAYS:ssa 3 prosenttia potilaista osallistuu kliinisiin tutkimuksiin (Lääkärilehti/ajassa). TYKS:ssä, OYS:ssa, ja KYS:ssa on menossa 15, ”noin 10” ja ”yli 10” syöpälääketutkimusta.  Artikkelin mukaan HUS Syöpäkeskuksessa olisi menossa ”noin sata syöpälääketutkimusta”. HUS julkisten sivujen tutkimusluettelossa (hus.fi) on nelisenkymmentä Syöpäkeskuksessa menossa olevaa tutkimusta, joista osa on rekisteri- tai seurantatutkimuksia, joissa ei ole varsinaista kokeellista hoitokomponenttia. 

Luultavasti tässä on appelsiinit ja omenat sekaisin, sillä jos kliinisten lääketutkimusten määrään lasketaan mukaan muut tutkimukset, esimerkiksi näytteillä tehtävät analyysit, laboratoriotutkimukset ja rekisteritutkimukset, jotka kaikki tarvitsevat klinikan tutkimusluvan, luku nousee huomattavasti. Saamani henkilökohtaisen tiedonannon mukaan alle 5 prosenttia HUS syöpäklinikan potilaista osallistuu kliiniseen tutkimukseen, vastaten kansainvälistä keskitasoa.

Lääkärilehden artikkelin mukaan HUS tutkimusjohtaja on sitä mieltä, että ”suomalaisilla syöpäpotilailla on kohtuullisen hyvät mahdollisuudet päästä lääketutkimuksiin”. Itse olen eri mieltä tästä. Jos tautiin kuolleisuus on lähes 100 prosenttia, niin varmasti useampi kuin yksi kahdestakymmenestä haluaisi harkita osallistumista kliinisiin tutkimuksiin. Kaikki uudet hoidot joita nykyään käytämme, olisivat olleet saatavilla kliinisissä tutkimuksissa 5-10 vuotta aikaisemmin. Kliiniset tutkimukset säästävät veronmaksajien rahaa, sillä sponsorit maksavat lääkkeen ja lisäksi usein huomattavia kompensaatioita sairaalalle.

Yksi näkökulma pohdintaan onko syövän hoito Suomessa hyvää vai huonoa, on potilaiden mahdollisuus osallistua kliinisiin tutkimuksiin. Tällä on merkitystä erityisesti niiden potilaiden kannalta, jotka eivät ole rutiinihoidoin parannettavissa. HUS ja TAYS osallistumisprosentit ovat 3-5 välissä ja muissa yliopistosairaaloissa ne ovat vielä matalampia. Yhdysvaltalaisissa huippusairaaloissa päästään 30 prosentin paikkeille (Unger et al). Eurooppalaisen OECI akkreditaation alaraja on 10 prosenttia, joten tähänkin on vielä matkaa.

Yhteenveto

Suomessa viiden vuoden selviytyminen syöpädiagnoosin jälkeen on maailman huippuluokkaa ja tämä tulos saadaan kohtuullisin matalin kuluin. Luultavimmin tulos selittyy pääosin hyvällä diagnostiikalla ja erinomaisella syöpävalveutuneisuudella. Teknisesti hoidoissa ei ole paljonkaan puutteita verrattuna muihin vauraisiin maihin, mutta uusien lääkkeiden käyttöönotto on meillä hidasta. Esimerkiksi immunoterapioiden käyttöönotossa Suomi poikkeaa selvästi rikkaista ja keskirikkaista EU maista, ja olemme jopa Unkarin, Puolan ja Portugalin alapuolella (Jönsson).

Toinen selvä kehittämisalue on potilaiden kokemus hoitoprosessista. Jonotus hoidon ja diagnostiikan eri vaiheissa, sekä lääkäreiden vaihtuvuus turhauttaa potilaita ja omaisia. Kliinisiä tutkimuksia on harvoin tarjolla suomalaisille syöpäpotilaille. Tämä vähentää potilaiden pääsyä kaikkein uusimpiin hoitoihin. Syövän hoitoon käytetyt resurssit ovat vähäisiä verrattuna taudin aiheuttamaan tuottavuuden laskuun.

Viimeaikaiset tulokset immunoterapiassa ovat osoittaneet, että lääketieteen kehittymiseen liitetty toivo ei ole millään tavalla turhaa.

Akseli Hemminki
Syöpätautien professori, syöpätautien ja sädehoidon erikoislääkäri

Viitteet ja linkit
Hemminki A. Kuoleman Laakso. Voiko syöpää hoitaa kokeellisilla menetelmillä? Nomerta, Turku. Ilmestynyt englanniksi 2015 ja suomeksi 28.4.2016. http://www.nomerta.net/kirjat.php


http://www.hus.fi/tutkijalle/hus-tutkimuskeskus/tutkimus-husssa/Sivut/default.aspx, haettu 27.12.2018

https://www.iltalehti.fi/syopa/a/201808032201114159 (Syöpäbiologian professori: Uusimmat lääkkeet puuttuvat Suomesta, Suomi on kaukana syöpähoidon mallimaasta)

https://www.iqvia.com/

https://www.laakarilehti.fi/ajassa/ajankohtaista/syopalaake-tutkimuksiin-paasy-vaikeutui-pohjoismaissa/


http://www.oeci.eu/

Jönsson et al. Comparator report on patient access to cancer medicines in Europe revisited. IHE report 2016:4. www.ihe.se

Knaul FM et al. Closing the cancer divide: an equity imperative. Boston, MA: Harvard University Press, 2011.

Mariotto et al. J Natl Cancer Inst. 2011 Jan 19; 103(2): 117–128.

Unger et al. Am Soc Clin Oncol Educ Book. 2016; 35: 185–198. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495113/.

Voda and Bostan. Public Health Care Financing and the Costs of Cancer Care: A Cross-National Analysis. Cancers. 2018; 10(4): 117.

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  16. Do you seek spiritual help ? AchieversSorcerer@gmail.com we offer all kinds of help to enable you live a desirable life. A white magic that will enable you achieve all your heart desires Achievers sorcerer is 100% guaranteed for all the helps you need ? contact Dr Dada via AchieversSorcerer@gmail.com For unlimited lottery predictions and winning ,For Cure to all kinds of diseases For success in carrier Please Fill the Form Below:
    - Complete Name
    - Type of help needed- City / Country:
    - Telephone: A lots of people have gained through the help of Dr Dada: Contact now via AchieversSorcerer@gmail.com

    ReplyDelete
  17. Hello i want to share my amazing experience with the greatest spell caster Dr omohan my husband was cheating on me and when i found out we had a fight which lead to him filling for a divorce i cried and fell sick when i was searching about love quotes online i saw people talking about him and his great work whose case was similar to mine they left his contact info i contacted him and he told me not to worry that after 24hrs he will cancel the divorce and be back to me after i did everything he asked me to do to my greatest surprise the next day evening it was my husband he knelt down begging me to accept him back,thank you once again Dr omohan you are indeed a blessing to me he can also help you contact email: dromohanspell@gmail.com WhatsApp +2348164816038 

    ReplyDelete
  18. I want to share a testimony of how Dr.Osemuhau herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.Osemuhau herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. can contact him drosemuhau@gmail.com {) or call or what-apps him through +2348168714427

    ReplyDelete
  19. I want to share a testimony of how Dr.Osemuhau herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.Osemuhau herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. can contact him drosemuhau@gmail.com {) or call or what-apps him through +2348168714427

    ReplyDelete
  20. Hello everyone this is serious and real i want to tell the whole world about how DR DADA HERBAL MIXTURE product helped me enlarge my penis size ..i have trying since 25 years of age to enlarge my penis but none rendered me the help i want, i have used vaccines,penis pump,surgery,online creams from USA CAMBODIA,AUSTRALIA and many more but none of them enlarge my penis i was really frustrated and tired of living because my penis was too small ,imagine a cute and handsome 40 years old man like me having 3.5 inches and to make it worse i was having erectile dysfunction which was so annoying to me,my girlfriends have left me because of my small penis ....to GOD be the glory as i was searching for help on a Facebook page i saw one Mr Peter  from TEXAS testifying of how DR DADA HERBAL MIXTURE product enlarge his penis and healed his grand mom PROSTRATE CANCER .so i quickly  message him on his email drdadaspellhome7@gmail.com and he replied me and gave me comforting words and told me all i need to do and i was surprise when i got his product and he sent it to me through united parcel service (UPS) and i got it 4 days later and used the product just as he told me and its just 9 days of using his herbal mixture my penis is now 10 inches long and 8.0 flaccidity am so happy to feel like a man in the bedroom at last, so if you need penis enlargement,breast enlargement,weak erection,erectile dysfunction cure and many sexual relation cure do not hesitate to email him now drdadaspellhome7@gmail.com or drdadaspellhome@hotmail.com  you can also whatsapp him on +2348158568638 thanks

    ReplyDelete
  21. Hello everyone , this is the most wonderful thing i have ever experienced and i need to share this great testimony... I just want to say thanks to Dr OSOFO for taking time to help me cast the spell that brings back my ex lover who suddenly lost interest in me after six month of engagement but today we are married and more happier than never before. I was truly flabbergasted and shocked when Kris started begging for forgiveness and for me to accept him back.. I am really short of words and i don't know how much to convey my appreciation to you Dr OSOFO you are a God sent to restore broken relationship. He deeply enjoy helping people achieve their desires, find true love, getting their ex lovers back, stop abusive relationships, find success, attract happiness, find soul mates and more. Contact him today, and let him show you the wonders and amazement of his Love Spell System. He deliver results at his best in real spell casting. Send an email {osofo.48hoursolutioncenter@gmail.com } WhatsApp him on: +2349065749952        

    ReplyDelete
  22. My name is Ryan am from U.S.A. I want to share a testimony of how Dr. DADA  herbal mixture cream saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I can't make love to my wife and my penis was just too small a full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.DADA herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is inced 8 es and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. You can contact him via {drdadaspellhome7@gmail.com) or call him or what-apps him through +2348158568638 .he also specialize on the following things
    BREAST ENLARGEMENT
    BREAST LIFT & REDUCTION
    PENILE/PENIS ENLARGEMENT
    GENERAL BODY SLIMMING
    HIPS & THIGH REDUCTION
    Thanks for the Enlarging my penis sir, you indeed save my marriage...I am really grateful sir,..,,

    ReplyDelete
  23. HOW DR PERFECT ENLARGEMENT CREAM HELP ME TO ENLARGE MY PENIS YOU CAN ADD HIM UP ON WHATSAPP +1(256) 251 3614

    My name is David Richardson from USA I want to share a testimony of how Dr Perfect herbal mixture cream saved me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing and I was also having weak erection problem. I can't make love to my wife and my penis was just too small, a full grown man like me having 3 inches penis and to worsen it I don't last long in sex I can't even last four minutes it was really a big shame to me. My wife was really tired of me because my sex life was very poor, she never enjoyed sex, I was always thinking and searching for solutions everywhere until when I saw a testimony of how Dr Perfect herbal mixture cream have been helping people regarding their sex life, so I decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 10 inches I couldn't believe my eyes and as I speak now my penis is now 10 inches long and I don't have weak erection anymore. I can make love to my wife longer in bed. And my marriage is now stable my wife is now enjoy me very well in bed. All thanks to Dr Perfect for enlarging my penis he indeed save my marriage. You can contact him at solutiontoallproblems1@gmail.com or you can add him up on WhatsApp +1(256) 251 3614. you can also view my blog http://davidrichardson12356.over-blog.com. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others 

    ReplyDelete
  24. I want to share this wonderful testimony to the Good people all over the world on how I was able to Enlarge my Penis by Dr. Sikama. I was living a shameful life from my young age, just last month as I was browsing on the internet about Penis size and Enlargement Products, I saw a testimony of a Man called George , testifying of how he was able to get his penis Enlarged by Dr. Sikama and I decided to also Email Dr. Sikama for my small penis size and he quickly respond to me and gave me the normal instructions which i did and then he shipped the product to me here in the united state which i received in just 3 working days and today i am very happy because i started seeing positive changes in my penis size in just 7 days of use. Dr Sikama herbal product is the best recommended for you and to whom ever suffering from this shame or having any other diseases as well should Contact this great herbal doctor via his Email : adrsikama@gmail.com and WhatsApp Him on +7 926 503-80-12

    ReplyDelete
  25. AFRICAN TRADITIONAL METHODS OF CURING HERPES THAT IS GOING VIRAL!
    Most traditional methods of roots and herbs today have been scientifically proven to cure almost all drugs resistant diseases without after effect.
    It worked for me years ago when I was depressed with herpes. After trying numerous other methods, It was actually an old Ibo lady who brought to my notice the healing effect of natural medicines. She too was permanently cured from HERPES long time ago through Dr Utu @ "drutuherbalcure@gmail.com" who among few, specialises in African roots and herbs for medicinal cure. Apparently roots and herbs have well been known as effective key treatment for herpes. She introduced me to Dr Utu who till date remain my savior, and he truly cleared my doubt. After taking his medication on the fourth week, I contacted him again who asked me to go for test and I was negative. From then till now I do my normal business no outbreak. I may not be a herbal fan but it definitely worked for me!

    ReplyDelete
  26. I thought the physicians said there is no pills or another way for PENIS ENLARGEMENT !!! I am telling you today that Dr Aziba has the product for PENIS ENLARGEMENT and it worked perfectly for me from 3:0 to 8:95 and still counting. Contact Dr Aziba for help to Enlarge your penis via Email Address: priestazibasolutioncenter@gmail.com and also reach him on WhatsApp with mobile number: +2348100368288
    and please lets keep sharing this solution to other fellow men around the world with living with such mess.

    ReplyDelete
  27. I have used Dr Aziba herbal Medicine cure remedy for 2 WEEKS now. So far, it has cured my HERPES, eliminated my COLD SORE, improved energy and metabolism, in the morning I feel recharged and I no longer feel sleepy after a meal. As for the scent, it does smell like motor oil but I chase it down with 100% Herbal medicine from Dr Aziba. twice a day AFTER a meal. I also experienced vivid dreams for about 5 days now it’s diminishing to during the first 2 or 3 hours of sleep . contact Dr Aziba: EMAIL: priestazibasolutioncenter@gmail.com or whatsapp +2348100368288 and He also have herbs medicine to cure some popular diseases....
    Some other areas of your health you may need Dr Aziba help to get cured.
    {1}Diabetes
    {2}HPV
    {3}ALS
    {4}Herpes
    Contact
    Dr via Email: Priestazibasolutioncenter@gmail.com
    WhatsApp : +2348100368288

    ReplyDelete
  28. I have used Dr Aziba herbal Medicine cure remedy for 2 WEEKS now. So far, it has cured my HERPES, eliminated my COLD SORE, improved energy and metabolism, in the morning I feel recharged and I no longer feel sleepy after a meal. As for the scent, it does smell like motor oil but I chase it down with 100% Herbal medicine from Dr Aziba. twice a day AFTER a meal. I also experienced vivid dreams for about 5 days now it’s diminishing to during the first 2 or 3 hours of sleep . contact Dr Aziba: EMAIL: priestazibasolutioncenter@gmail.com or whatsapp +2348100368288 and He also have herbs medicine to cure some popular diseases....
    Some other areas of your health you may need Dr Aziba help to get cured.
    {1}Diabetes
    {2}HPV
    {3}ALS
    {4}Herpes
    Contact
    Dr via Email: Priestazibasolutioncenter@gmail.com
    WhatsApp : +2348100368288

    ReplyDelete
  29. What a beautiful and wonderful testimony, sometimes things you don't believe can just happen. My name is Adams Vera, from U.S.A am 28 years old i got married at the age of 24 i have only one child and i was living happily. After three years of my marriage my husband behavior became so strange and i don't really understand what was going on, he packed out of the house to another woman i love him so much that i never dreamed of losing him, i try my possible best to make sure that my husband get back to me but all to no avail i cry and i cry seeking for help because i was heart broken until i coincidentally came across an online spell caster called Dr. Osasu , i contacted him and explained to him what i have been going through in my marriage and he gave me the full assurance that my husband will come back to me and my marriage will be restored, He told me what to do to get my husband back and i did, he said after 3days my husband will come back to me and start begging, it really happen it was so surprising and everything was just like a miracle, ever since my family have been living with so much happiness and our relationship was now very tight because of this great and powerful spell caster.he is a very great and powerful spell caster that can be trusted and there is nothing concerning life issues he cannot solve because i am a living testimony. i know there are so many people out there who are going through similar problems in one way or the other, believe me this is the right spell caster to contact and all your problems will be forgotten. contact Dr. Osasu viaWhatsapp: +2347064365391 Email:Account drosasu25@gmail.com

    ReplyDelete
  30. My name is Joel dwin  am from Texas US. I want to share a testimony of how Dr DADA herbal mixture product saves me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing,and i was also having weak erection problem. I cant make love to my wife and my penis was just too small, a full grown man like me having 4 inches penis and to worsen it i don't last in sex, i cant even last two minutes it was really a thing of shame to me. My wife was really tired of me because my sex life was very poor,she never enjoyed sex,i was always thinking and searching for solutions everywhere until when i saw a testimony of how Dr.DADA  herbal product have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 8 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. You can contact him via drdadaspellhome7@gmail.com call or whatsapp him +2348158568638

    ReplyDelete
  31. Hello everyone this is a testimony of how a man named Dr Thomas gave me the reason to be happy again.
    I was having small penis and weak erection problem. I can't even make love with my girlfriend for 7 minutes and my penis was just too small a full grown up man like me having 4 inches penis and to worsen it i can't even last more than 3 minutes in bed, it was really a shame to me. I came across Mr Williams  testifying on how Dr Thomas save him from shame too,  so I decided  to give a  try to his products.  So I talk with him he told me that all everything will be alright that my penis will increase after he is true with what he was about to do. At  forst I thought it was a joke but in less than a week after taking some of his products  my penis  increased from 4 inches to 7 inches and I started lasting in bed for 30 minutes.  So i  called him and told him about it he told me that it was just the beginning that I will also last longer than that.
    As I am talking with you now my girlfriend can now enjoy me in bed.
    you can contact him for  more information's. you can contact him on his email : (Doctorthomas73@gmail.com).
    Or you can also contact him on what's app :(+2348152190329).
    He is also specialize on the following:
    1.Body enhancement 
    2.COPD(Chronic obstructive pulmonary disease).
    Thanks for enlarging my penis sir,  I am so grateful.

    ReplyDelete

  32. Herbal Penis Enlargement product is 100% guarantee to Enlarge and get a better ERECTION , the reason why most people are finding it difficult to enlarge Penis is because they bedlieve on medical report, drugs and medical treatment which is not helpful for Penis Enlargement . Natural roots/herbs are the best remedy which can easily Enlarge your Penis permanently Contact Dr DADA via Email : drdadaspellhome7@gmail.com or via WhatsApp : +2348158568638 for Natural root and herbal remedies put together to help you get Enlarge and Erect healthy. Thank you

    ReplyDelete
  33. Hello everyone i am here to share a testimony of how Dr.Thomas herbal mixture cream saved me from  shame i have tryed so many ways everywhere until when i saw a testimony of how Dr.Thomas herbal mixture cream have been helping people regarding their sex life, so i decided to give him a try and to my greatest surprise in less than TEN DAYS of taking the herbs my penis grow to 7 inches i couldn't believe my eyes and as i speak now my penis is now 9 inches and i do not have week erection again. I can make love to my wife longer in bed. And my marriage is now stable,my wife now enjoy me very well in bed. you can contact him for more information's.(Doctorthomas73@gmail.com) or call or what-apps him through +2348152190329. he also specialize on the following things 1. CANCER
    2. ALS (Lou Gehrig's disease)
    3. COPD (chronic obstructive pulmonary disease) 
    Thank you sir, you indeed save me. 

    ReplyDelete
  34. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Clara David I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is Sandra David I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the roots and herbs to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man @herbalist_sakura for my younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com or whats app him
    +2348110114739  you can follow him up on Instagram @herbalist_sakura for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com 

    ReplyDelete
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    ReplyDelete
  36. I want you all to help me thank dr irosi for saving my life, i was diagnosed of herpes and at the same time i was 7 months pregnant, i was confused and i didn't know what to do until i meant a friend on the Internet who directed me to dr irosi did not believe it until i contacted the good man who was able to help me out of the situation with his herbs, it only cost me some little amount of money to cure herpes through dr irosi so i will also advice any body that needs help from him should contact him because i know you will also get cured of your disease. Thanks once again dr irosi. Anyone who needs help having the same disease should contact him on his email drirosisolutioncenter@gmail.com or call/whatsapp him via: +2348118829771   

    ReplyDelete
  37. OMG!! This is certainly a shocking and a genuine Testimonies. I visited a forum here on the internet on the 20TH OF OCT 2020, And I saw a marvelous testimonies of this powerful and great Doctor called PRIEST AZIBA on the forum. I never believed it, because I never heard nor learnt anything about Natural Enlargement Products. Nobody would have been able to influence me about Natural Enlargement Product not until PRIEST AZIBA did it for me and restored my Penis to a Normal size which i was very ok to have(11inch) he ask if I want to increase it further more i told him am ok with this I have now, so I’m recommending y’all in same situation to contact DR AZIBA via Email: PRIESTAZIBASOLUTIONCENTER@GMAIL.COM and also Contact him on his whatsApp +2348100368288 I am really short of expressions, and i don’t know how much to convey my appreciation to you PRIEST AZIBA you are a God sent to me and my entire friends whom has also use your product.. And now I am a joyful man with my family. here is DR Email and WhatsApp contact below Email: priestazibasolutioncenter@gmail.com & WhatsApp:+2348100368288

    ReplyDelete
  38. OMG!! This is certainly a shocking and a genuine Testimonies. I visited a forum here on the internet on the 20TH OF OCT 2020, And I saw a marvelous testimonies of this powerful and great Doctor called PRIEST AZIBA on the forum. I never believed it, because I never heard nor learnt anything about Natural Enlargement Products. Nobody would have been able to influence me about Natural Enlargement Product not until PRIEST AZIBA did it for me and restored my Penis to a Normal size which i was very ok to have(11inch) he ask if I want to increase it further more i told him am ok with this I have now, so I’m recommending y’all in same situation to contact DR AZIBA via Email: PRIESTAZIBASOLUTIONCENTER@GMAIL.COM and also Contact him on his whatsApp +2348100368288 I am really short of expressions, and i don’t know how much to convey my appreciation to you PRIEST AZIBA you are a God sent to me and my entire friends whom has also use your product.. And now I am a joyful man with my family. here is DR Email and WhatsApp contact below Email: priestazibasolutioncenter@gmail.com & WhatsApp:+2348100368288

    ReplyDelete
  39. Hello, everyone! I'm here to explore blogs and forums about the wonderful and most safe cure for (Herpes Virus). I was positive about the deadly virus called herpes and I lost hope because I was outcast and rejected even by my closest friends. I searched on-line to know an enquirer cure for Herpes and I read someone's testimony on how he was cured from Herpes so I decided to contact the same herbalist because I know that nature has the power to heal everything. I contacted him to know how he can help me and he told me never to worry that he will heal me with the natural herbs from God! After 2 days of contacting him, he told me that the cure has been ready and he sent it to me via DHL and it got to me after 3 days! I used the med as he instructed (MORNING and EVENING) and i was cured! it's really like a dream but I am so happy! That's the reason I decided to also add more comments on Him so that more can be saved just like me! and you can get in touch with him via email chiefdrlucky@gmail.com or WhatsApp  +2348132777335 Kindly visit website https://chiefdrluckyherbaltherapy.wordpress.com/

    ReplyDelete