New drug for impotence gets standing ovation --- But companies not jumping to add Viagra to benefits
Paul Dalby
04/17/1999
The Toronto Star
Life looked good for 75-year-old Norm Cohen. He was happily married and still working in the same job he had loved for the past half-century.
But he was becoming impotent. The Toronto insurance broker says it preyed heavily on his mind.
"It gave me a real shot in the head worrying about the physical relations with my wife," says Cohen, whose wife Joan is 45.
"I thought, Jesus, I'm getting older and I just won't enjoy my life. Like most men, my ego is just too big to think otherwise."
Then he was prescribed a small blue pill called Viagra , the new wonder drug for treating men with erectile dysfunction.
Cohen started taking Viagra a year ago before it was available in Canada. His urologist, Dr. Jack Barkin, simply faxed the prescription to a New York state pharmacy, which in turn mailed the tablets to Cohen's home in Toronto.
Viagra was officially approved for used in this country by Health Canada last month.
Since starting Viagra , Cohen has never looked back.
"Using Viagra is great and it works, but it's just as important knowing I have Viagra in the house whenever I need it," he says. "It takes a lot of pressure off."
His is not an isolated case. There are about 3 million men in Canada suffering from erectile dysfunction. And until now it has been one of the most misunderstood medical conditions affecting men in transition from middle age to senior status.
An American study found that the percentage of men affected is directly related to their age. In 40-year-olds, it was 40 per cent, 50-year-olds registered 50 per cent and so on, with 70 per cent of 70-year-olds affected.
"It's mind-boggling to see how many of these men are devastated by erectile dysfunction," says Barkin. "Without the ability to have an erection, they are not whole men."
Chief of urology at Humber River Regional Hospital, Barkin says the arrival of Viagra has brought impotency out of the closet.
"Erectile dysfunction used to be an issue that the patients did not talk about, and worse, the doctors never asked questions about," he says. "They felt, why ask the question if you can't offer a viable treatment."
Those alternative treatments included direct injection of drugs into the penis, using suppositories inserted into the urethra, surgery or using a vacuum device to cause the penis to fill with blood.
Some of these therapies can be painful and all of them work without the need for sexual stimulation, which is likely to have a profoundly unsettling effect on the man's partner.
In contrast, Viagra is the first oral treatment with only minor side effects (facial flushing, minor headaches and stomach upset in some patients) that successfully treats erectile dysfunction.
It increases blood flow to the penis enabling a man to have and maintain an erection, but he still needs sexual stimulation from his partner.
In extensive clinical trials, seven out of 10 men taking the pill were able to have successful sexual intercourse.
Viagra is now available from any drug store in Canada with a doctor's prescription at a cost of about $13 per tablet, plus dispensing fee.
The drug was invented by the New York-based pharmaceutical giant Pfizer Inc.
Its Canadian subsidiary, Pfizer Canada, is now making applications to all the provinces for Viagra to be covered on public health plans.
If approved, this would make Viagra available free of charge to all seniors, probably the most affected age group.
"The point we've made to all the provinces is that erectile dysfunction is a medical condition often caused by another medical condition," says Don Sancton, corporate affairs director of Pfizer Canada.
"That includes prostate surgery, diabetes, high cholesterol levels, spinal cord injury, depression, hypertension and other heart conditions. So Viagra should be seen as a treatment for that medical condition."
An impending election may persuade the Harris government to add Viagra to the Ontario drug plan list, if only to court the seniors' vote.
The picture is not much brighter for Viagra to be included on company drug benefit plans. Green Shield Insurance has offered to include Viagra in drug plan packages for all its corporate customers.
It would add five per cent to the cost of the plan to cover eight tablets a month up to a yearly maximum of $1,200.
"Almost all the companies have so far declined," says Green Shield's Jim Bates.
"Many of these companies are actually trying to reduce the cost of their plans."
So far it looks like "pay as you go" for Canada's impotent men.
Pfizer warns that any man with a serious heart condition being treated with nitrates cannot take Viagra .
Ontario urologist Dr. Richard Casey cautions: "If you suffer from heart problems, suddenly having penetrative sex is a bit like jogging or running after a long time as a couch potato."
That's why doctors insist on giving every new patient a thorough physical examination before he can be prescribed Viagra .
It may not, however, be an instant cure for a marriage on the rocks.
"We tell our patients that Viagra may help your erection but not necessarily your sex life," points out Casey, director of the four Male Health Centre clinics in the province.
"If they have had no sex since the man became impotent, then the guy takes Viagra and gets an erection, the woman may well ask: "Where have you been for the past five years?"
"That's why we prefer to give counselling to the man and his partner before we prescribe Viagra ."
Pfizer Canada is quick to dispel one myth about Viagra , namely that it can enhance a healthy man's performance between the sheets.
The drug firm states emphatically Viagra is not an aphrodisiac and will not increase a healthy man's sexual desire or libido.
If you don't have erectile dysfunction, don't take the medicine for it, the company advises.
Viagra has become a household name in record time.
Doctors already predict the new drug will be to impotence what Prozac was to depression a decade earlier.
"It's a revolutionary drug," says Barkin.
"And most important, it affords the patient a degree of respect. It's not something they will be embarrassed about."
WONDER PILL: Norm Cohen, left, talks with urologist, Dr. Jack Barkin about Viagra he has been taking for a year for erectile dysfunction. Before it was approved here, his doctor faxed the prescription to a N.Y. pharmacy, which mailed pills to Cohen.
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