Sorry, this is long but I haven't figured out how to post a link yet. If someone wants to enlighten me, I'd appreciate it!
Thought this covered alot of the things we have been discussing. Sorry if it is a "repeat".
E'Lane
Newsweek 5/4/98 Business/ Drugs: Take a Pill And Call Me Tonight
5/4/98
Viagra's debut makes medical history, but it won't help everyone
By Jerry Adler
It's got a great name, evocative of "vigor" and the immense power of Niagara. The New York Daily News breathlessly reported last week that the pope had approved it (it was actually an informal group of Vatican health officials), but even without a papal imprimatur, Viagra was making medical history as the most successful prescription-drug introduction ever --remarkably enough, for a pill that can't help you live longer, grow hair or lose weight. What it does, of course, is help men achieve and sustain erections, and its appeal was summed up by Bill Devine, a urologist in Cedar Rapids, Iowa, whose office switchboard suffered a meltdown under the heat of incoming calls after the drug went on sale in early April. For the typical middle-aged man suffering from impotence caused by peripheral vascular disease--hardening of the arteries leading to the penis--Devine lays out the alternatives. "You can live with it; never having sex again won't kill you. You can have me implant a device in your scrotum; you can inject a drug into your penis, you can insert a suppository up your urinary tract--or you can take a pill an hour before sex." Guess which they all choose?
As one measure of their unanimity, doctors wrote 120,000 prescriptions for Viagra in the third week of April. That compares with 5,000 prescriptions in the first month for Fen-phen, the diet drug that everyone wanted last year, until it was discovered to cause heart-valve problems. A typical prescription, says the manufacturer, Pfizer, was for 10 to 15 pills, which sell at retail for about $10 apiece--making Viagra a product worth $600 million to almost $1 billion a year right out of the gate. Sales of highly touted drugs often slow with time, as some patients find they don't work for them and others experience side effects. Even in trials, Viagra worked only about 70 percent of the time. And probably at least some of the "patients" seeking Viagra last week had confused it with an aphrodisiac, which it isn't; it works only in the presence of sexual stimulation.
Moreover, Viagra won't have the market to itself forever; there are at least two other pills and a topical gel now in tests. One of the pills, Zonagen's Vasomax (produced under license by Schering-Plough), has a biochemical mechanism similar to Viagra's and could be ready for sale late this year or next. But the potential market is vast--at least a substantial fraction of the 10 million to 20 million American men who suffer some degree of impotence. This is a horde certain to be augmented by male baby boomers turning 50 at the rate of 5,000 a day over the next decade.
And there's other competition, of a sort: Vaegra, a mail-order vitamin supplement, and Viagro, which was available over the Internet for $99 from a Brooklyn physician who billed it (in small type) as an "herbal analog of the new popular impotence pill." (Pfizer sued both outfits for trademark infringement.) Viagra itself, although generally in good supply at regular pharmacies, was also being heavily marketed online. The J&D Pharmacy in Warsaw, Mo.--a town of 1,500--sold 10,000 pills in a week to customers who saw its Web advertising and mailed or faxed in prescriptions from as far away as New Zealand. The Viagra craze was calling attention to the burgeoning Internet trade in pharmaceuticals, which has worried health officials for some time. You need a license to open a pharmacy, but anyone can put up a Web site and start mailing pills all over the world. A legal over-the-counter drug in one country--or, for that matter, a sugar pill--can be advertised as anything and sold anywhere, to people who may have no idea what they're getting. Mail-order frauds are investigated by the Postal Service, but no one is policing cyberspace. The Internet, said Jeff Stier of the American Council on Science and Health, "is the new medium for the snake-oil salesman."
Equally worrisome to health officials--but more susceptible to regulation--is the practice of physicians' prescribing Viagra and other drugs over the Internet without ever seeing their patients. A Milwaukee urologist who advertised on the Web offered phone consultations and a Viagra prescription for $50. A story in The Wall Street Journal prompted questions from the state licensing board, and the offer was withdrawn. But no one knew how many others were doing the same thing.
This is a practice Pfizer and most medical authorities strongly discourage. A physician who never sees his patients obviously is in no position to look for side effects. So far Viagra seems not to have many --although often, as was the case with Fen-phen, these show up only after a drug is in widespread use. The bigger danger is that impotence can be a sign of an underlying condition, such as diabetes or hypertension. "Proper diagnosis," says a Pfizer spokeswoman, "involves a physical exam and a complete history, and that must be done in person."
But impotence can also be a symptom of nothing more than growing old, and a pill that can reverse it almost at will could make a huge contribution to the world's happiness. Mike Moran, a La Grange, Ill., urologist, has written 40 prescriptions for Viagra, and asked his patients for feedback; he hasn't heard back from even one. "Usually, when a therapy fails, I hear from patients quickly," he says. "It must be working." Moran's first prescription was for a 77-year-old man he had been treating for several years; the patient requested 1,000 pills, planning to make up for lost time. (He got 30.) If Viagra lives up to even a fraction of those expectations, Pfizer could be reaping profits for years to come.
With Brad Stone in New York and John McCormick in Chicago |
