TILLOTSON: Eros in a pill.
Viagra was supposed to be the second stage of the sexual revolution, the
pharmacological answer for every man who could not achieve an erection.
When Viagra hit the market last April, doctors were writing as many as
300,000 new prescriptions for the pill every week, over $400 million in sales
in the first three months. But for the three months after that, sales had fallen
to under $150 million, and the FDA has also reported 69 men died after
taking the pill; most of them had other health problems.
On the phone with us from the Maryland suburbs of Washington, Doctor
Myron Murdoch. He's a urologist who says some of his own patients have
been on the Viagra roller coaster.
Doctor Murdoch, thank you from joining us.
DR. MYRON MURDOCH, IMPOTENCE INSTITUTE OF AMERICA:
I'm happy to be here.
TILLOTSON: Tell us about your own experience and your own practice. A
great rush for prescriptions, that's dropped off?
MURDOCH: That's right. In the first three months, we had a tremendous
rush. A huge pent-up demand that had probably been developing over the
year previously with everybody hearing about and waiting for Viagra to be
introduced to the public. And then once it became FDA approved, I think it
was March 27, 1998, it was a huge rush with this pent-up demand for
Viagra, and that demand has dropped off in the last six months.
TILLOTSON: I must ask you, when you say demand has dropped off, is
that demand for new prescriptions or are the folks you first wrote
prescriptions for still getting them refilled? Or do you even know?
MURDOCH: Well, I'm writing about 50 prescriptions a day for Viagra.
TILLOTSON: That's still a lot, isn't it?
MURDOCH: That's a lot of Viagra for one doctor to be writing, but my
practice is basically involved in the diagnosis and treatment of male sexual
dysfunction.
But in general, the same urgency that patients have had to get their Viagra is
not there. People are still -- still having -- you know, there's three-million
American men out there with a sexual dysfunction, and most of them will
respond to Viagra. But we don't see the demands that we saw in the first
few months, and this tremendous rush that we had, this absolute "I must get
my Viagra" concept. It's not there anymore.
TILLOTSON: Doctor Reichman, I must ask you -- and please stay on with
us, Doctor Murdoch -- I wonder if there was perhaps some hype about the
miracle of Viagra at first, if there's a little alarmist reporting about the 69
deaths from men who had used it.
REICHMAN: Viagra...
MURDOCH: I think the media hype...
TILLOTSON: I'll let you back in a second.
Go ahead, Doctor Murdoch.
MURDOCH: The media hype has really -- really helped promote Viagra,
but on the other hand, we have many men who won't take Viagra because
they are afraid of the potential cardiac side effects. We have lots of wives
and partners of men who could use Viagra who feel very uncomfortable
about potentially making their husbands or partners ill from a drug that in fact
is not a necessary drug for their health.
Women and partners of men who demand that their husbands perform or
partners perform or who desire them to perform become very guilty when
they think about the possibilities this drug may cause side effects.
But the reality is the drug really works for the bulk of patients, 75 to 80
percent of patients, and it really doesn't cause many side-effects.
TILLOTSON: Doctor Reichman I want to bring you in, and it's my
understanding from the stats I've seen from FDA that the vast majority of
men who died while using this drug had other pretty, serious health
problems.
REICHMAN: Many of them were taking nitroglycerine at the same time,
and that's a contraindication because they both work through something
called nitric oxide. Some of them had very high blood pressure or were on
anti-hypertensive medications. Viagra will decrease blood pressure.
Also, if you take 30 million men, or how many started to use or need to use
it, and -- we don't have a control. Some of these men were sick, they were
old, they had heart conditions, and they may have died from unrelated
causes or from the exertion of simply being sexually active when they hadn't
been for a long period of time.
It's interesting that the media brought this V-Day into being an extremely
important time. Everyone wanted to get it. I think that for those whom it
works, and it works about 70 percent of the time in making the erection
good enough for vaginal, natural intercourse, those individuals will probably
want to continue using it.
It does have side effects. It can cause flushing, blue vision, a feeling of heat
coming to the face, some nausea, a runny nose and some men simply don't
like the side effects.
It's interesting. Here we have a tremendous media output surrounding the
issue that: Oh my God, we now have a drug to treat impotence.
And we're not supposed to use that word anymore, it's erectile dysfunction.
There was an NIH conference that said this is the right term to use, but
there's never been an NIH consensus conference on women.
We don't think that women are any different from men in having problems,
either with their sexual function, their libido. And there's never been a drug
that's been directed directly towards women.
We're looking at some of the issues with use of Viagra in women with
testosterone. And believe me, we're not going to get the HMOs or insurance
companies to pay for this right now. And there's a big issue: Well, they're
paying for men, but they're not paying for women.
They're not even paying for contraception in women, is this right?
TILLOTSON: We've got to take one more break.
When we come back, I'd love all of you to talk about this more
philosophical, on the medical question of: Are Americans unique among
people in the world in hoping if they just find the right pill, they can have a
grand sex life, they can lose weight and they'll be happy all the time?
Stay with us. Be right back. (COMMERCIAL BREAK)
TILLOTSON: Welcome back.
We're talking about Viagra; sales have dropped off of it.
Doctor Murdoch, still a booming industry, though, if you are writing 50
prescriptions -- what did you say? A week?
MURDOCH: A day.
TILLOTSON: A day?
I'm curious whether Americans, based on what you know about the drug,
are buying more Viagra than anybody else and whether that is because we
all, in America, believe if we can only find the right pill, life will be perfect, or
if it's just because we are so prosperous that more men here can afford that
very expensive little drug.
MURDOCH: I think it's one of prosperity. I think the Pfizer company
determined that in the United States they could probably make more money
than elsewhere where there's many, many more government controls on
what they can charge for drugs because most of the other countries in the
world have some kind of a socialized medical system.
On the other hand, I think if you look in terms of societies around the world,
sexual function is much more important in other societies, especially in
Southeast Asia and China where Viagra hasn't even been allowed to enter
yet. So I think in the future, you're going to be seeing Viagra in other areas
of the world.
We already -- it's already being offered in Europe and in some areas of
South America. And I think when it finally reaches the Far East, you will see
many, many -- much more in the way of sales in the Far East than you would
see...
TILLOTSON: And more girl babies up for adoption, maybe.
Susan, I've going to interrupt Doctor Murdoch to ask you whether it is true,
as Doctor Reichman says, that most HMOs are paying for Viagra
prescriptions but not for contraception. Both would seem to be sort of
lifestyle enhancing. I mean, a lot of couples would think to have no more
than 5 kids would be very life-enhancing.
PISANO: Well, actually, about 90 percent of health plans provide coverage
for contraceptives. That's a fact and I think that it's been acknowledged.
There's a mixed reaction to Viagra. Some plans have said the use of this
drug will cause us to raise premiums for all of our patients; is that the right
thing to do?
TILLOTSON: You're saying it's a myth that Viagra is covered for
reimbursement and contraceptives are not? PISANO: There's more of a mix
on the Viagra than on the contraceptive side. Contraceptives are covered by
about 90 percent of health plans. And on Viagra...
REICHMAN: Not contraceptive birth control pills. And if we write
prescriptions for birth control pills for contraception only, the patient has to
pay on many of these plans. If we write a prescription and say it's for
cramps or for heavy bleeding, then the plan will pay.
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The above are excerpts from the transcript of the following program, aired on CNN on October 22:
More Doctors and Patients Leave HMOs; Care and Coverage Examined - October 22, 1998
cnn.com
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