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Biotech / Medical : VVUS: VIVUS INC. (NASDAQ) -- Ignore unavailable to you. Want to Upgrade?

To: Bradpalm1 who wrote (4754)	1/18/1998 11:48:00 PM
From: DR. BOND	Respond to of 23519

Bradpalm1.....Good Evening and Hope you are well! Your questions raised a very valid and interesting point. Not being an MD., I can only attempt to answer this question from my perspective. I agree, most PCP's will initially want to treat ED with a "path of least resistance" therapy like Viagra, an oral drug vs MUSE, a local drug that takes much more MD time and energy to prescribe. However, not knowing the true effectiveness of Viagra within certain ED patient pools as well as more details on Viagra's side effects and labelling, I believe that it is still too premature to get an accurate answer to this question. VVUS the company contends that no one drug will handle or cure the complex problem of ED, and thus the market will support multiple treatment programs for multiple stages of ED. Viagra/MUSE could be possibly one such treatment plan. Also, some PCP's may want more "proven patient statistics for men using Viagra " before they actually write a script for such a new drug whose side effect profile may not yet be truely known for some time. As for the ad $ spent, I believe it is money well spent, so these PCP's at least know that a PROVEN, LOCAL, and EFFECTIVE therapy for ED is already available and until Viagra is approved (and I believe it will), these PCP's can atleast begin to provide some answeres and solutions to those patients who wish to seek treatment know! Just a thought! Take Care, DB PS. Take Denver plus the pts.!

To: Bradpalm1 who wrote (4754)	1/19/1998 12:36:00 AM
From: Cacaito	Respond to of 23519

If Primary Care Physicians could charge for the "work up" then they will be willing to try a lot. If not able to charge for "work up", a quick prescription with minimal intervention will be the case, then viagra is the obvious choice, and definitely they will send the patient to the Urologist. Not the case for the best private practice physicians. The marketing campaign is ok, most physicians are not aware of Muse. They could save more money stopping the buyback of shares, but I guess they have some weird reasons for it. Dr Bond, Side effects? Not a problem for most practitioners, except for geriatrics specialists. If the other guys are at it, then they will jump or the patient will go somewhere else, like the Redux/Prozac cases.You will see practices solely dedicated to viagra prescriptions, maybe in the gyms.

To: Bradpalm1 who wrote (4754)	1/19/1998 12:46:00 AM
From: Zebra 365	Read Replies (2) \| Respond to of 23519

Managed Care is the answer...... Bradpalm1 asks: <<<Let me propose a hypothetical question. Once Viagra is approved and released, why would a PCP bother with the time-consuming task of prescribing and titrating Muse dosages in the office? If some of these patients eventually fail Viagra, I believe that they would be far more likely to refer them to a urologist for further evaluation and management rather than turning to a more invasive treatment option. Therefore, could the money that Vivus spent spending on the marketing material and video tape in those yellow boxes sent to PCPs been better spent? >>> Very good question. Let me reply, as a primary care physician, (with a well-known pro-VVUS position) First, I do agree that Viagra MAY be the first drug of choice, but I will have to see the list of Known contraindications, side effects, and potential drug-drug interactions first. I'm not an "early adapter" of most drugs, I let them do Phase IV studies on someone else's patients. Many of my patients are now pleased (as am I) that I did not fulfill their requests for Redux. <<<Once Viagra is approved and released, why would a PCP bother with the time-consuming task of prescribing and titrating Muse dosages in the office?>>> The reality of medical practice means that many drugs are not used the way the manufacturer recommends. Many urologists are not doing in-office titration. They are sending the patient home with a mid-range dose of 250 or 500 Ug and instructions to "try a single, if no effect in 20 minutes, double it". Along with precautions regarding syncope, of course. The PCP can do this as well, in fact this was suggested to me by a urologist who I was calling about his opinion on MUSE. <<<I believe that they would be far more likely to refer them to a urologist for further evaluation and management rather than turning to a more invasive treatment option.>>> It is, for many managed care plans, very time consuming to obtain permission for a specialty referral. This involves phone calls, paper work, and revealing the medical condition to multiple third parties before permission is obtained. Frankly, with the video, the dummy MUSE unit, and the toll-free number so further questions can be handled by Vivus nurses, it would be less time consuming for me to teach the patient, hand him the video, caution him about syncope and head to the next patient, than it would be for me to obtain permission for a urology referral. <<<Therefore, could the money that Vivus spent spending on the marketing material and video tape in those yellow boxes sent to PCPs been better spent?>>> I agree that many PCP's will not be prescribing MUSE or Viagra because it is out of their comfort level to treat this condition. But Doctors are supposed to be experts, they don't like to learn about a new treatment from a patient who has seen it on TV during a golf tournament. For Vivus to do a direct-to-consumer promotion without a PCP education program would be very bad, it would embarass some PCP's. That promo box allows the PCP to at least have handled and seen the MUSE unit, so that they will be aware of the existance of MUSE and can descibe it to the patient as an option. Many PCP's simply are bombarded by so much information, that they are not yet aware of this product. Certainly if I were not involved in the stock market, I would never have heard of MUSE until I received a letter from a urologist about a patient referred for ED treatment. I listen to conference calls for one reason. Rarely is it to get the scoop on information. I listen to hear how the CEO responds to questions. Some questions will get perfunctory answers, and some will trigger the CEO's hot button, his vision. Small companies need leaders with vision and the vision has to have a direct parallel to the success of the company. I think Leland Wilson has been frustrated that MUSE has been so sucessful that marketing has not been needed to date. His "hot button" is pharmaceutical marketing, and Vivus is just now getting to the stage where demand creation is beneficial and Vivus has the war chest to do it. I think the size of the ED market, once consumers are made aware that there is an effective treatment, will surprise us all. Didn't mean to write a book. Zebra