A year in the Viagra nation
ELIZABETH NEUS
03/15/99
Gannett News Service
FINAL
The little blue sex pill with the name that conjures a gushing waterfall was an instant sensation when unveiled a year ago.
Viagra even knocked President Clinton's blossoming sex scandal off the front pages and became the punch-line for the pros like Letterman and Leno and the amateurs at your office coffee machine.
The blazing attention given to a drug that helps men overcome impotence should have been no surprise. An estimated 30 million men suffer from what doctors prefer to call ''erectile dysfunction,'' and the omnipresent baby boomers are reaching an age where sexual difficulty is more likely.
But Viagra was the first simple treatment for the problem, one that did not involve injecting or inserting or implanting something into the penis. One pill, combined with a few suggestive thoughts and a willing partner, could bring on an erection in many men who had gone years without one.
''It was the typical American cultural solution -- here's a pill, take a pill, everything will be better,'' said Greg McGreer, a Philadelphia-area psychotherapist who specializes in sexual dysfunction and who takes Viagra himself.
And that pill struck a nerve.
The hype surrounding its launch -- little of it orchestrated by its maker, Pfizer Inc., which did not start a formal advertising campaign until recently -- was bright enough to blind.
''I think we were a little surprised by how quickly it happened,'' said Pfizer spokeswoman Mariann Caprino.
Issues of physical dysfunction became entangled in issues of libido and desire. This would be the start of the sexual revolution for men, as important as The Pill had been for women. Relationships would change in ways we couldn't even imagine.
Actual events triggered by the drug just kept the hysteria rolling. Sales soared to $788 million in just eight months. Bob Dole announced he used Viagra -- and liked the results. People from other countries made special trips to the United States to pick up Viagra . Angry patients sued insurance companies that refused to pay for the budget-busting drug. Fears grew as tales were told of men who had died having sex after taking Viagra .
In some quarters, what happened with Viagra -- insurance problems, dangerous side effects, patients clamoring for prescriptions, media attention -- was seen as something that could have been possible with any major drug launch. Only this was on a far higher plane, and tinted by the link with sex.
''The talk is all about Viagra , but it could be any drug,'' Caprino said. ''It's been held to a different standard. The more people who know about a product, the higher on everyone's radar screens it is, and you're more likely to hear about problems.''
A year later, we've caught our breath.
Now that the novelty of hearing Tom Brokaw say the word ''erection'' on the nightly news has subsided, now that the land-rush mentality has disappeared from urologists' waiting rooms, it is clear Viagra 's impact has been world-wide.
And the major effect is the one that doctors who treat impotence had hoped.
''Now everyone talks about it. People are less embarrassed about having erectile dysfunction. It's wonderful to have a lot of different options to treat these men,'' said Dr. J. Francois Eid, director of the Erectile Dysfunction Unit at the New York Hospital-Cornell Medical Center.
Viagra gives men a conversational gambit to broach the delicate subject with busy doctors.
''It's one way to bring it up,'' said Edward Laumann, a Pfizer consultant and University of Chicago sociology professor who recently wrote a major study on the prevalence of sexual dysfunction. ''I think physicians are very poorly trained to take a sexual history. They're very uncomfortable with it. And if you're only going to see somebody for 10 minutes, you don't want to start something like that.''
Doctors wrote more than 7.6 million prescriptions for Viagra in the eight months it was on the market in 1998. Refills began to outpace new prescriptions by September, and the overall number of prescriptions has fallen off, according to IMS Health Inc. which collects prescription data.
While it overwhelmed the market for erectile dysfunction treatments -- a competitor fell from a 95 percent market share to just 2 percent after Viagra -- the pill never sold as well as the hype would have you believe.
The top-selling drug in the last quarter of 1998 actually was Premarin, an estrogen replacement for post-menopausal women. Premarin prescriptions totaled 11.8 million; Viagra accounted for 2.2 million.
Urologists find that more and more of their new cases actually are Viagra failures, and makers of competing treatments report their prescription numbers are rising again as a result. Primary care physicians, who do not have the special training necessary to explain the more complex impotence treatments that work where Viagra doesn't, still can write a prescription.
The deaths put a damper on some of that. Between late March and mid-November 1998, 130 Americans died after being prescribed the drug. Most had risk factors that should have eliminated them as candidates for Viagra use, and they died soon after taking the drug.
Pfizer made the guidelines more clear, and cardiologists' associations also issued strong warnings about who should receive the drugs. Some doctors even suggested that men undergo cardiac stress tests before getting a prescription.
A few doctors tried to eliminate patients based solely on age, but an 80-year-old man capable of playing three sets of tennis a week isn't physically the same as one whose major daily activity is punching the buttons on the TV remote. Many had forgotten that sexual intercourse was exercise.
''When the most stressful thing you do all day is to get out of bed and go to the kitchen table -- it was the sex that killed them, not the Viagra ,'' said Dr. Geoffrey Sklar, a urologist at the University of Maryland Medical Center who was among the original Viagra researchers.
The Food and Drug Administration, which still considers the drug safe enough to stay on the market, no longer reports Viagra -related deaths on its Web site, although the curious can write a letter and ask for updated details. ''It served its purpose,'' said spokeswoman Susan Cruzan.
A handful of those who died had no apparent risk factors, or had coronary artery disease that was discovered only at autopsy. Erectile dysfunction with a physical cause does not come out of nowhere, urologists say, and doctors should check for cardiac problems in men who have trouble maintaining erections.
''We had patients whose only significant problem was impotence,'' said Dr. John Mulhall, director of the Center for Male Sexual Health at Loyola University Medical Center in Maywood, Ill.
''They took a cardiac stress test, and they had abnormal stress tests two times as often as the average population of the same age. Anyone who's graduated medical school in the last 10 years has to have an indication that impotence is a vascular disorder.''
What they also hope people understand is that the restoration of sexual function may not be a quick fix for a broken relationship. Counseling is a major part of treatment for erectile dysfunction; doctors are happiest when both members of a couple show up for an appointment.
''The women are, I hate to say it, much more realistic about this. They can put sex into perspective,'' said Dr. Andre Guay, an endocrinologist and director of the Center for Sexual Function at the Lahey Clinic near Boston.
Although nearly every urologist in the country can moan at will about the wannabe Lotharios that show up in their offices -- the 70-year-old man who left his 61-year-old common-law wife of 10 years so he could play the field is a particularly famous tale -- they also say that most patients act like adults.
''You don't hear about the 55-year-old couple who can't have sex and the pill has done amazing things for them,'' Mulhall said. ''That is the overwhelming majority of my couples.''
''It's not changing relationships, it's not changing people, it's not changing habits, it's just allowing men who couldn't be sexually active to be sexually active,'' said Dr. Andrew McCullough, director of male sexual health and fertility at the New York University Medical Center.
True, the introduction of Viagra may change an individual relationship. A couple may have deluded themselves into thinking their troubles stem from the fact that they cannot have intercourse. They can then be surprised to find -- when intercourse is back in the equation -- to find that the problem is more deep-rooted than just sex.
''We've had some divorces,'' said Guay. For those couples, he said, Viagra ''brought the issue to a head.''
Many myths still need to be overcome. Facts and pseudo-facts about Viagra long have been confused in the American mind.
Doctors regularly try to cool off elderly men who think Viagra will help them rock 'n' roll like a 17-year-old (well, maybe a 37-year-old); men and some women who believe the drug will boost their will to have sex as well as their physical ability -- it doesn't; men with normal sexual function who still believe that Viagra will make them sexual gods (get real).
''You get the weirdos and the macho men and the guys with three girlfriends,'' sighed Guay. ''A lot of (my patients) are very nice, but you've got the minority who want 30 pills a month.''
Some doctors report that the underground market for Viagra does exist, ''like in high school when people were trying dope -- 'Oh, man, it was so good!' ''Eid said, imitating a teen-ager. ''Men are still so immature.''
Despite the general willingness to talk about Viagra and the condition it treats -- Bob Dole's smiling face appears in Pfizer's newspaper and TV ads promoting awareness of sexual dysfunction -- more than a few men still find it mortifying to discuss, and not everyone wants to hear about it.
A recent editorial cartoon, for example, featured Dole brandishing a picture of his wife Elizabeth, who is considering a run for the Republican presidential nomination in 2000, as two hapless people and threatening, ''Vote for my wife or I'll tell you more about erectile dysfunction!''
Doctors think that craving for privacy on the issue is the reason for the burst of online sales of the drug, a practice currently under investigation by the National Association of Boards of Pharmacy and loudly protested by Pfizer.
''Is it getting easier to talk about? I was walking in Long Island past a T-shirt shop, and (one shirt) said, 'Real men don't need Viagra .' I think there's still a taboo there,'' said McCullough.
------
|
