Viagra's Bright Success Spotlights Dark Side Of Sex
June 01, 1998 1:04 AM
By Nancy Ann Jeffrey and Rochelle Sharpe, Staff
Reporters of The Wall Street Journal
As a million men have rushed to take the impotence pill
Viagra in its just nine weeks on the market, the biggest
drug craze since Prozac is spotlighting a new medical
risk: Thousands of patients with severe heart disease are
now able to resume intercourse, an intense physical
exertion for such a vulnerable population.
Since Pfizer Inc. began marketing Viagra in early April,
the sex pill has breathed passion into the lives of
countless couples long anguished by an inability to have
sex. But its overnight popularity raises concern that the
men who need it most are those least able to withstand
the rigors of sex - millions of men for whom impotence is
merely a side effect of heart disease and other serious
health problems.
Of seven known deaths of men taking Viagra, five died
of a stroke or heart attack during sex or shortly
thereafter. All are believed to have had a history of heart
disease or other cardiovascular problems. A sixth man
died because of a bad combination with a nitrate drug
commonly prescribed to heart patients. The cause of
death in the seventh case is unresolved.
This intersection of sex and death may pose a dilemma
for doctors: Should they prescribe Viagra even to
patients with the weakest hearts if these men demand it?
" This is an ethical issue," says Richard Conti, chief of
cardiology at the University of Florida College of
Medicine in Gainesville, Fla., and past president of the
American College of Cardiology. "Should we really be
advising our patients who are at high risk to use Viagra
just because they want to have sexual relations?"
The university's Health Science Center in Jacksonville is
investigating the death last month of a man in his 50s
who went into cardiac arrest while having sex shortly
after he took Viagra. He had a history of serious heart
disease.
The issue is at the forefront as almost 10,000 urologists
from the U.S. and overseas gather in San Diego this
week for the annual meeting of the American Urological
Association. Attendance was up almost 50% from a
year ago as urologists attended a standing-room-only
session on impotence yesterday morning, taking breaks
to trade the latest Viagra jokes and discuss the tradeoffs
between sex and risk.
The Pfizer sales booth at the San Diego Convention
Center was brimming with dozens of doctors, from
China to Turkey to Argentina and other markets around
the world where Viagra isn't yet sold but where
black-market pills can fetch $30 to $100 a pop. They
lined up for Viagra brochures, notepads in the shape of
the pill and lapel pins picturing the tablets. They begged
for free samples. (None are available.)
For American patients, the Viagra phenomenon is
shaping up as an extraordinary real-life science
experiment: What happens when a million men who had
stopped having sex resume all of a sudden? The early
results offer a reminder that sex brings problems as well
as pleasure.
"VIAGRA-MONY," blared the banner headline in the
New York Post after a Long Island woman sued her
10-year live-in mate for $2 million plus damages,
charging that Viagra helped the 70-year-old man have
sex for the first time in four years and that he left her,
with pills in hand, two days later to move in with another
woman.
In this frenzy, few men clamoring for Viagra are eager to
embrace such downers as heart risks. "I'm not worried.
After sex, I feel better than before," says Murray, 59
years old, who lives in the Fort Lauderdale, Fla., area
and has diabetes and bouts of high blood pressure. He
had been impotent for the past few years but, since
starting on Viagra six weeks ago, he and his wife have
resumed sexual relations at least once a week.
Murray, who asked that his full name be withheld, joined
a health club but never goes. He played an hour of tennis
recently and thought he would collapse with exhaustion.
But when he ponders nights on Viagra, a heart attack is
the last thing on his mind. "I don't care about living
forever," he says. "And I couldn't think of a better way
to go."
The advent of Viagra, doctors say, has sent thousands
to the doctor's office for the first time in years, affording
physicians the opportunity to catch long-undiagnosed
problems of heart disease, diabetes, prostate cancer and
other conditions that also cause impotency.
Some 30 million American men are impotent, and
serious cardiovascular problems are believed to be
involved in more than 60% of the cases. It isn't known
why these diseases render men unable to have sex,
except that the impotence neutralizes a source of
physical exertion that heart patients might be better off
without.
Viagra's label carries warnings aimed at cardiovascular
patients. One cautions a gainst combining Viagra with
nitrate medications, the contraindication that has resulted
in at least one death. On the drug's package insert,
distributed to pharmacists and physicians, Pfizer also
warns: "There is a degree of cardiac risk associated with
sexual activity; therefore, physicians may wish to
consider the cardiovascular status of their patients prior
to initiating any treatment for erectile dysfunction."
The question is whether doctors or patients will decide
where to draw the line. "It's not that the pill is bad, it's
that some doctors are prescribing it without a careful
examination" to patients who shouldn't be on the drug,
says Arnold Melman, president of the society for the
study of impotence and an impotence specialist at Albert
Einstein College of Medicine in New York.
But a doctor who refuses also knows his patient could
well get the drug from another physician. The urge to get
hold of Viagra has also added a new dimension of
disinformation: sometimes patients lie. "I've literally
yanked the prescription out of their hands because they
lied to me," says urologist William Steers of the
University of Virginia Medical School, who is presenting
new research on Viagra's potency at the conference.
He worries that his patients might fib about whether they
take nitroglycerin tablets, which would put them at risk
of death in taking both prescriptions. He calls their
cardiologists while they sit in his office to double-check.
The risk of a heart attack or stroke during sex arises in
much the same way as i t does during a run in the park.
Typically, when a man has sex, his heartbeat races from
80 beats to 150 beats per minute, his blood pressure
shoots up 66% to a systolic reading of 200, and his
adrenaline increases threefold. The extra adrenaline can
cause a blood clot, which can lead to a stroke or heart
attack; the increased blood pressure can cause a blood
vessel in the brain to burst, resulting in a stroke, says
James Muller, director of the Gill Heart Institute of the
University of Kentucky Medical Center in Lexington,
Ky.
To be sure, in heart patients the increased risk posed by
sex is less than the risk of playing tennis, jogging or
carrying firewood, Dr. Muller says. For a 50-year-old
man with heart disease, the chances of having a nonfatal
heart attack in an hour in which he has intercourse are
close to 30 in one million, compared with a risk of 10 in
a million for that same man in an hour when he isn't
having sex. Add to that the possibilities of sudden
cardiac death or stroke, and the chances that sex will
induce a serious cardiovascular event rise to 90 in a
million, still relatively low.
But if a man is sedentary, that picture changes for the
worse. Sedentary people who exert themselves increase
their risk of heart attack 100-fold, so the chances of a
nonfatal heart attack for a sedentary 50-year-old man
with heart disease in the hour he has sex rise to three in
1,000. That is three times the risk involved in a cardiac
catheterization, a common type of heart test, every time
that man has sex. "People ought to think twice about that
type of risk," Dr. Muller says.
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Robert Langreth contributed to this article.
Copyright (c) 1998 Dow Jones & Company, Inc.
All Rights Reserved.
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