Despite drastic drop in sales, Viagra still making history
By Larry Tye, Globe Staff, 10/22/98
ome men simply didn't get the results they'd been promised. Others
balked at the cost, not to mention possible deadly side effects. Then
there were those who found that Viagra boosted their confidence along with
their sexual performance - to the point where they could leave the
medication in the medicine cabinet.
All of which helps explain why sales of Viagra have fallen substantially from
the sky-high levels they reached in April, when the drug was released.
But even with that decline, reflected in sales figures released last week,
Viagra is on track to become the most successful new drug in history. And
Wall Street analysts, along with physicians who are prescribing the drug and
patients who are taking it, remain bullish about it.
''It's still the most successful drug ever. It's just not twice as much as the next
closest, the way it was,'' said Len Yaffe, a pharmaceutical analyst at
NationsBanc Montgomery Securities in San Francisco. ''We expected this
rapid uptake, the lull in between, and the flattening out.''
Dr. John Stripling, an Atlanta urologist who has prescribed the drug to about
2,000 patients, said that while he has seen interest wane somewhat, ''Viagra
still is the best in initial treatment and probably will be the gold standard for a
while.''
That's the way Paul, a 46-year-old who lives on the North Shore, sees it
too. He has been taking Viagra for four months to help him function sexually
after undergoing groin surgery stemming from a bicycle accident. The drug
''definitely works,'' he said. ''It's extraordinary; its effectiveness can not be
overstated.''
The only problem, added Paul, is that his health insurer limits reimbursement
for the drug, which can cost up to $10 a tablet. ''If it was any other organ,''
he argued, ''the insurance company couldn't say it just won't pay for it. It's
obscene.''
The Viagra craze began even before the drug came out last spring. The
media was awash with stories about how merely popping a pill not only
would cure impotence, but could let already potent men reach new levels of
performance. Within a week of its release, Viagra captured nearly 80
percent of the market for drugs to treat sexual dysfunction, and within a
month doctors were writing about 300,000 prescriptions a week.
Worldwide sales for its first quarter hit $411 million.
The sky seemed the limit, but the reality playing out on the ground was more
sobering, as became clear with last week's release of the latest sales
statistics: Prescriptions are down to about 170,000 a week. And worldwide
sales in the most recent quarter plummeted to $141 million.
One reason for the decline was a natural sorting out of those who didn't
really need the drug, or for whom it didn't work.
''The tidal wave of interest and desire is gone,'' said Dr. Abraham
Morgentaler, director of the male infertility and impotence program at Beth
Israel Deaconess Medical Center. ''It doesn't work quite as well as
advertised in the media, but clearly it works in about 50 percent of guys with
some sort of physical problem with their erection. ... It's not 90 percent, but
it's an amazing figure, and for those 50 percent it's fantastic.''
The way the drug works is relatively simple: The main problem for men with
impotence is that not enough blood gets into or stays in the penis to keep it
erect. Within an hour of taking Viagra, however, smooth muscles in the penis
are relaxed enough to let blood flow into the spongy tissue that becomes
engorged to cause an erection.
Viagra also has proven a boon to many men whose troubles in sustaining an
erection are psychological, although many of them aren't getting new
prescriptions. ''They may still have tablets in the bathroom,'' said Stripling,
the Atlanta urologist. ''Just knowing it's there, they can go to bed with more
confidence.''
The fear of potentially deadly side effects is another reason for the drop in
sales. Such fears were fanned when the US Food and Drug Administration
reported last summer that at least 69 men taking Viagra died during its first
four months on the market.
The FDA and Pfizer Inc., the drug's manufacturer, say that death toll is low
given that more than 2 million men had taken the drug, and many of those
who died were old or sick enough that it probably was from overexertion.
They also point out that the drug carries a warning against taking it if you are
on nitroglycerine or other nitrates.
But Dr. Sidney Wolfe, director of the Washington-based Health Research
Group, said that those warnings aren't sufficient and that many would-be
Viagra users have come to realize that ''having an erection is really important,
but it's not worth dying for.''
For those not at risk, and who liked the drug when they first tried it, there's
another reason not to sign up for refills: It's simply too expensive.
Some HMOs have been paying for the pill, but they often make doctors and
patients fill out so many forms certifying that they suffer from dysfunction that
it has discouraged them from filing for reimbursement. Other insurers will
only cover it under special, more expensive policies.
''We figure that about 50 percent of insurers and managed-care companies
will reimburse for it, and we're hoping to see that increase over time,'' said
Mariann Caprino, spokeswoman for Pfizer.
Even with the dampening of interest and those disincentives for use, Viagra
still is almost sure to become the best-selling new drug ever. The
record-holder is Lipitor, a cholesterol-lowering drug released last year that
earned just over $1 billion during its first 12 months. Viagra is on track to
earn more than $1.1 billion by the end of its first year, said Yaffe, the
investment analyst, and that's based on reaching just one-fifth of its market of
an estimated 20 million American men who suffer from impotence.
One of those men is a 46-year-old from Milford who asked that his name
not be used. ''I've tried other treatments and methods,'' said the man, who
has been taking Viagra four to five times a month for four months. While he
has experienced some side effects, including flushing, headaches, and
heartburn, he said, ''They're insignificant compared to the results we've
achieved. My wife and I are feeling very good about it. We're very satisfied
and very pleased.''
This story ran on page A01 of the Boston Globe on 10/22/98.
© Copyright 1998 Globe Newspaper Company.
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