To: Michael Burry who wrote (28421 ) 5/22/1998 5:47:00 PM From: George Acton Respond to of 132070
I agree with everything you said, and would be even more skeptical of the whole thing. Guys have been dying in the saddle for a long time. Before Nelson Rockefeller, there was a French politician just before WW I (being French it was with his mistress, of course). So it could have been coincidental. We don't even know how long after taking the drug they died, what the mechanism was (coronary, stroke, blowing an aneurism). We don't know how many they took, and Vigra seems to be exactly the kind of drug people will take too many of. If one is good, then four must be ecstasy, huh? And we'll never have some of this information accurately. I was living on the Right Coast when Rockefeller died and there were a lot of rumors, but nothing official in the press. If you'll excuse the pedantry, the second messanger for Viagra is cyclic GMP. Retinal cells run on cGMP too, which accounts for the visual side effect. Viagra reversibly blocks the breakdown enzyme for cGMP in a way that's similar to the way coffee and tea block the breakdown enzyme for cAMP. This particular subtype of enzyme for cGMP occurs mostly in erectile tissue and eye -- it's a genius application to have worked this out. At any rate, there's no reason to expect Viagra to any more dangerous than coffee. The next step in the pathway for Viagra is that cGMP turns on an enzyme to make nitric oxide (NO), and this acts on the muscle. Nitrates like nitroglycerine and inhalants like amyl nitrite get broken down to NO directly. It's a straightforward additive effect, so it could produce hypotension, but it shouldn't be that dangerous. The lifetime of NO is measured in seconds to a few minutes. But if a guy has bad enough coronaries that he needs nitroglycerines, he's more vulnerable. Marketwise, this may be irrelevant. The medically honest market for Viagra isn't that large -- males with impotence based on real organic lesions. Traditionally, uses of medical technology beyond that was syspect. A much larger market is people with the decline in libido that goes along with aging. And the huge market is recreational -- 35 year old men who want to be 20 again, 25 year olds who want to be 15. Not to mention women. (I think I can speak for most males in observing that there's a considerable subjective difference between sex leading to orgasm and sex that doesn't. I can't see why a member of the stronger sex wouldn't feel the same way.) The only way you can justify Pfizer's share price is if these off-off-label use becomes widespread. The deaths may add to the allure of the drug for some people. It's like the cult of fugo, the Japanese fish that has to be prepared with special care because the internal organs have a megalethal toxin. It is said that some chefs are popular because they let a teeny sliver of toxic tissue slip in, and the diner gets a twinge of tingling in the hands and flush in the cheeks. But obviously people who get off on this are a tiny, sick minority. The mass of our fellow citizens have exemplary mental health and would never take unnecessary risks, much less pay good money to do so. --George Acton