Healthy Skepticism Library item: 2006

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: news

Viva Viagra
2002 Nov 2

Full text:

Viagra has become the fastest selling pharmaceutical drug in history. Four Corners examines who’s buying and selling Viagra in Australia, and who will pay the price. Is Viagra a medical or a marketing miracle?

————-
Reporter: Liz Jackson
Producer: Rebecca Latham
Research: Neheda Barakat

Reporter: Liz Jackson
Producer: Rebecca Latham
Researcher: Neheda Barakat

Tracy Cox, Broadcaster 2-Day FM:
You talk to anyone about Viagra and they’ve got a ? they’ve got an opinion about it. They have no idea how the drug works, they’ve got no idea whether it’s applicable to them or not. But men are going like oh I wanna get some then I’ll be able to, like have sex all night.

Liz Jackson:
Viagra has become the fastest selling pharmaceutical drug in history. In the first six months in the United States 150 million pills have been consumed. Seven weeks ago Viagra was released in Australia.

Frank Latimer:
I’ve never looked back since. It’s good value, excellent.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
Many people will benefit, some people will die.

Liz Jackson:
Tonight Four Corners examines who’s buying and selling Viagra in Australia, and who will pay the price. Is Viagra a medical or a marketing miracle?

Alec Thomas is coy about his exact age, but he’s old enough to no longer care what other people think.

Alec Thomas:
Other people’s thoughts are their own, not mine. What other people think doesn’t bother me. I believe that live your life while you can, because you only live once.

Liz Jackson:
Alec’s had blood pressure problems, and probably as a result of the drugs he’s been taking for it or maybe just his age, over the past five years he’s developed impotence.

Alec Thomas:
Very disturbing because I believe that.sex is part of love, if you make love that you’d you feel ? a man must feel that he can go on with the meaning of the word love.

Dr Phillip Stricker, Urological Surgeon:
Fifty per cent of 50 year olds have some erection problem, but if you’re talking about total erection problems, it’s probably less than 10 per cent at that age, but if you go up to the 70s and 80s, it’s probably more like 50 per cent of people have close to total erection problems.
Q: And how many do you think are candidates for Viagra?
A: I think an enormous number of people are candidates for Viagra.

Liz Jackson:
Alec’s wife died six years ago, so the problem has not been pressing, but nine months ago, he met a girl in Adelaide and today he’s getting married.

Alec Thomas:
I decided that I need, at this stage in life, that I needed company. And if you’ve got company of a younger person, and you’re gonna love that person, which I do, then I’m going to do something about myself, to be able to make her happy and thus the use of Viagra.

Liz Jackson:
Alec has given Viagra, a couple of test runs, it didn’t work. It’s not surprising really, because he just sat alone at home waiting for a response. That’s not the way the drug works.

Dr Rosie King, Australian Centre for Sexual Health:
Viagra works by enhancing the normal physiological responses that accompany arousal. In other words, you must be turned on up here for your body to turn on. Once your body has started to turn, the Viagra will promote and facilitate that. In other words, Viagra does not create arousal.

Alec Thomas:
My doctor suggested that if one didn’t work, to take two. And then he recapped on that and said take one-and-a-half first, to see if it works. And, at this stage, that’s what I’ve got to do, and ? to find out whether it works.

Liz Jackson:
Viagra is creating a new sexual etiquette, which couples are just beginning to tentatively negotiate.
Q: And you’ve talked over this taking of Viagra with Linda?
A: Yes, she’s not worried about the sexual side of life. She loves me and without any reservation at all.

Marriage Celebrant:
There will be the tears, there’ll be the joy and there’ll be the fun.

Alec Thomas:
It’s possible to love somebody without sex, but I believe sex is the ultimate, is the end of love-making, not the beginning, the end. You love somebody and then you have sex. You don’t have sex without love. I don’t.

Liz Jackson:
Alec is unconcerned that treating what may be just a natural part of getting old, will place him at risk.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
Viagra can be risky for old men because if old men have not been having sex for some time, the exercise associated with having intercourse could put them at risk of a heart attack.

Alec Thomas:
No, no, my heart’s as good as gold. I’ve been told by the girl that tested my heart that my heart’s as – is excellent. But she did add ? for my age.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
As they get older and the arteries around their heart get narrower, it may become less and less safe to use this drug, but many people are not going to be keen to give up something that’s been working for them. So it’s going to be a long time before we know what the death rate will be from this drug.

Amanda Dwyer, Salon Kitty’s:
Forty per cent of Salon Kitty’s clients are over the age of 45, and they are the gentlemen who are affected most by problems with erection or lack of performance. And what I’ve found is gentlemen are terrified of not being able to perform.
Q: Of the guys that come here, what sort of percentage would now be looking towards using Viagra?
A: I’d say with our clientele, seeing that a lot of them are older gentlemen, I’d say at least 30-40 per cent, definitely.
Q: What concerns do you have about it?
A: I am concerned that someone might die on the premises. Naturally, in my position, that would be something horrific. That’s never happened here before, so I don’t want to have it happen now.

2-Day FM:
Female: “Up close and personal” with Tracy Cox, get your love life back on track.
Male: What are we going to talk about tonight Tracy?

Tracy Cox, Broadcaster, 2-Day FM on radio:
Tonight we’re gonna tackle a very touchy and for guys, very embarrassing subject, what happens when your penis refuses to rise to the occasion.

Tracy Cox, Broadcaster, 2-Day FM:
Their self confidence goes down, their self esteem goes down, I mean often they won’t speak to their partner or anyone else about it because its so embarrassing, its unmanly.

Liz Jackson:
Four years ago, Frank Latimer was side-swiped in his car. The accident severed his spinal cord, and he left hospital with no movement and no feeling from the waist down.

Frank Latimer:
I was married at the time, I went home and tried to have sex with my wife, and I just had all sorts of troubles, yeah, it wasn’t a real successful attempt.

Liz Jackson:
His wife left him, the way Frank sees it, with nothing but his computer, her poodle and a major problem when it came to forming another close relationship.

Frank Latimer:
I felt sort of embarrassed even to some degree that there you are, you’ve, you know, got a lady friend and when it comes to love-making, you know, you knew that you couldn’t really do a satisfactory job. So yeah, I tended to not get involved, not want to, simply because of that fact.

Liz Jackson:
Eighteen months ago, Frank was invited to participate in the Viagra trials. Worldwide over 3,000 men took part, to test the efficacy and the safety of releasing the drug. Up to that point Frank had been using what has been the major form of impotence treatment ? injections in the penis, effective for him, but unappealing.

Frank Latimer:
If you’ve got a partner, then you’ve got to say well hang on, wait there. You’ve got to race down and then get an injection and then insert it, and that really does turn a lot of people off, even yourself. But just the thought of sticking needles into your penis, well, people shudder at the thought of that.

Liz Jackson:
While generally a safe and effective treatment, injection therapy created a very profitable niche market in which specialist clinics have sprung up offering private cures to an embarrassing ailment. The NSW Health Department has just completed an inquiry into these kinds of clinics.

Merrilyn Walton, Commissioner, NSW Health Care Complaints Commission:
It became very clear there is an aggressive advertising campaign targeting vulnerable group in the community ? older men, and many of them were 70 years plus, who were pensioners, who were being, in our view were potentially exploited both financially and medically.

Dr Phillip Stricker, Urological Surgeon:
Q: Can you tell us some specific examples of how they’re exploited?
A: Well I think the commonest thing that we see is patients who have psychological relationship issues who then ? they focus on the erection-side-of-things, and just ? some of the injection clinics will just give them injections. And of course there are side-effects of injections, such as penile curvature and scarring, and that then causes a physical problem which they previously didn’t have, when the original problem was really a relationship issue which was never addressed.
Q: And how much are they paying for the benefit of developing a physical problem they never had?
A: I think your question is saying how much do they pay for the medication? It varies across-the-board. At one stage, there was ? it was up to $500 for a bottle of medication.

Merrilyn Walton, Commissioner, NSW Health Care Complaints Commission:
Q: There seems to be evidence that Viagra will, in a sense, undercut these clinics and undermine them.
A: No, I don’t think that it will, I think it will just be yet another thing that these entrepreneurs can target the community with.

Liz Jackson:
Frank was treated by a reputable doctor. His problem was clearly physical, and in his case, Viagra worked like a charm. The drug’s manufacturer, Pfizer claims a 68 per cent improvement rate for men whose impotence is organically based. While that falls to around 43 per cent where impotence follows prostate cancer, an impressive 83 per cent of spinal patients respond positively to the drug. It’s an insight into the physiology of sexuality, that although Frank feels nothing from the waist down, the Viagra still works.

Frank Latimer:
I find that Viagra, for me anyway, it heightens my sexuality and it actually ? and even sometimes when I just see a pretty girl walking down the street, and I look at that, and I think wow, very, very nice, and then just those thoughts bang I sometimes I even get an erection for that, and that hasn’t happened for, well since my accident anyway, so yeah it’s great.

Liz Jackson:
The multi-national company Pfizer, discovered the effects of Viagra by chance. Scientists at their British base subsidiary, were conducting trials on a drug that would increase blood flow to the heart, to relieve angina. The trial was a failure but many of the men declined to return their pills. Many angina sufferers have impotence problems.

Dr Phillip Stricker, Urological Surgeon:
When Pfizer realised that the reason why these people were declining it, was because they were all keeping their erections whereas they previously didn’t have them, of course, they realised they were onto something as big as Ben Hur.

Liz Jackson:
It turned out the drug was targeting an enzyme that predominantly affects blood flow to the penis, not the heart. It’s blood flow to the penis that causes erections.

Dr James Barada is a Urologist who conducted some of the trials on Viagra in the United States.

Dr James Barada, Urologist, Pfizer Trials:
Well right now the penis is at rest. And as these cool colours show there’s very little blood flow into the penile tissue. After the Viagra dissolves it effects an enzyme that is found in the penile tissue, this results in smooth muscle relaxation, bringing blood flow into the penis, as shown here by the warmer colours. Right here we can see that there is smooth muscle relaxation which results in increased blood flow. So, not only does Viagra enhance an erection, it also maintains the erection as well.

Dr Joe Pollack, Men’s Medical Clinic:
I think that the drug is wonderfully convenient. To just be able to take a pill one hour before planned sex is almost science-fiction material, even for the late 1990s.

Noel Chapman:
Sexual activity up until the time that I had a problem was more-or-less on a spontaneous basis, whereas now, with taking the tablet, it needs to be considered like 40/45 minutes before, and so there’s a sort of a communication has to take place ? yes, you know, sexual activity will take place, or you know and so on. It’s a little bit different in that way.

Liz Jackson:
Noel Chapman was one of the men who took part in the Viagra trials conducted for Pfizer at the Keogh Institute for Medical Research in Perth. Here they keep their Viagra supply in the fridge and under lock and key. While the doctors were never able to find a physical reason for Noel’s impotence, after 18 months on the drug, he’s now a Viagra convert.

Noel Chapman:
Q: How long do you think you’ll be on Viagra?
A: Oh I don’t know, probably for life I suppose, the way things are, yes, it looks that way. Yeah, so I suppose I’m gonna be a regular customer.

Liz Jackson:
Noel has noticed, but he’s not bothered, by the side effects of Viagra.

Noel Chapman:
It does have some effect on your.blood circulation system, because that’s how the thing operates, and you can tell by the different reactions of your body that something’s happening to the vascular system. You get this flushing of the cheeks and things like that, and so it does have some stimulative effect to the rest of your body.

Dr James Barada, Urologist, Pfizer Trials:
The enzyme that Viagra affects is not found just in penile tissue, it’s found in every part of the body. And some people have more and some people have less. And that’s why some people have some specific side effects related to the Viagra.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
The thing with Viagra is it’s acting on a very specific mechanism ? one that really relates to the penis only, so it’s proved to be a very effective and very safe drug.

Liz Jackson:
Pfizer launched Viagra in Australia two months ago. It was fast-tracked through the approval process, just before the Federal Election. Impotence consultants from the medical profession, were invited by Pfizer to speak at the launch.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
What we now are entering is an era where an orally active medication that is effective for most men and safe to take will be an important addition to the non-invasive treatments.

Liz Jackson:
Many like Professor Lording are paid by Pfizer to assist the company with their expertise.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
You can take a tablet that will help with erection difficulties in most situations. And it says on the bottom, so why suffer in silence?

Liz Jackson:
The big drug companies now sponsor most of the medical conferences, and are the major source of research money.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
Q: Do you think that creates an uncomfortable relationship ? too cosy?
A: No, I think we’re talking about mature clinicians by and large, and I think these people have a very responsible attitude to their work and their role. I mean, if you want to maintain your position as an opinion leader, you can’t afford to be seen to be in the pocket of some vested interest group. Your colleagues would not allow you to maintain your position for too long if you did that.
Q: But the critics ? do the critics get invited to the conferences as well?
A: Who are the critics?

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
Many doctors have swallowed a very simplistic line. I think that there hasn’t been enough emphasis placed on the complexities and on the risks. I think that Pfizer have taken an approach which will maximise sales, rather than maximise safety.

Liz Jackson:
Dr Peter Mansfield is one of the critics. He’s a GP in Adelaide. Dr Mansfield doesn’t see the drug company reps who call at his surgery, and two days a week he works for a medical lobby group that monitors the truth in advertising of the big pharmaceutical companies.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
I was at a meeting yesterday evening with other, you know, fellow G.P’s. They said they’re just starting to prescribe Viagra. Some of them have been to an education session that was funded by Pfizer, but they weren’t told that there’s already been a death in Australia, and I think that they would be ? want to be more cautious about prescribing it if they knew that.

Liz Jackson:
Noel Maddern ran this car auction yard in Sydney. He was 53. In July this year he died in the arms of a 18-year-old prostitute. A bottle of Viagra was by the bed. Maddern, it has to be said, was suffering from a serious heart disease. The Coroner is investigating the cause of his death. While Maddern’s death has provoked little attention, the spate of heart attacks and deaths in the United States have been a public relations nightmare for Pfizer.

Diego Padro:
I don’t think an erection is something to die for.

Liz Jackson:
Diego Padro from New York has been featured on television telling his story. After experiencing some impotence problems brought on by diabetes, he approached his doctor for Viagra.

Diego Padro:
He said, here I have a sample that you can take, and in fact he had a bottle of Viagra sitting right on his desk, right in front of me, so I took that. But the problem quite frankly was not all that serious, at least in my particular case. But I thought that if it would enhance my performance I would do it.

Liz Jackson:
After three or four days using the drug, Diego says he felt weak and lethargic, and returned to his doctor.

Diego Padro:
When I got to his office he put me on an electrocardiogram device. And he announced that I was in the middle of having a heart attack and to get myself over to the hospital immediately. When I got to the hospital the emergency room people were there waiting there for me with their Id’s and their oxygen and all of that. I could understand if I’d had heart disease in the past or, you know, some reason for any of the electrocardiograms that I had taken show to show some problem with my heart, but none of that was happening.

Liz Jackson:
Diego cannot prove that Viagra was connected with his heart attack. The drug has been assessed and approved as safe by the US Food and Drugs Administration, the FDA. But as with all new drugs the FDA is keeping a watching brief, and posting any adverse reactions on their web site. The latest figures posted there lists 69 deaths associated with the use of Viagra, in the first four months after its release in the United States. Alarming though this figure appears, it is not statistically significant, given that some 300,000 prescriptions are being written every week and men do die during intercourse.

However, in the big US hospitals like this one in San Francisco, where some of the patients who suffered heart attacks were treated, they’ve seen a disturbing trend emerge, because impotence is often a symptom of the very medical conditions that make taking Viagra a risk.

Dr David Campen, Permanente Hospital Group California:
Individuals who have, to a large extent, peripheral vascular disease, resulting from diabetes, hypertension, smoking, high cholesterol. And in that population, you give them a drug which lowers blood pressure and you give that in a setting of an acute exertion activity. It would seem that you’re going to put that population at risk.

Liz Jackson:
The American College of Cardiology cautiously echoed these concerns in a statement last month. For a small group of patients with pre-existing heart, vascular and difficult to treat blood pressure problems, they warned against the potentially hazardous impact of the cardiovascular effects of Viagra. Pfizer disagrees.

James Price, Product Manager, Viagra, Pfizer Australia:
We think it’s great that cardiologists are getting involved in looking at the issues behind Viagra, and hopefully in Australia and around the world you’ll see a consensus of opinion on what the status is.
Q: Great that they’re saying that your product may be hazard ? hazardous?
A: Well I think it ? I think it’s good that people are getting involved. We don’t believe that the drug is hazardous, for people ? it doesn’t have any direct effect on the heart, I think that is incorrect.

Dr Peter Thompson, Cardiac Society of Australia & New Zealand:
The clinical trials have shown no adverse effects as far as the heart, although it was quite clear from the start that this drug could not be mixed with the nitrate group of drugs. But the clinical trials are only the start of the experience.

Liz Jackson:
No-one doubts that combining Viagra with the nitrate group of drugs can kill you ? 12 out the 69 men who died had this drug combination in their bodies. Both drugs cause blood pressure to drop, and together they can simply stop the heart from beating. The danger is that nitrates are routinely given by paramedics to men who’ve suffered heart attacks.

Dr Phillip Stricker, Urological Surgeon:
I think what has to happen is there has to be an education system coming in for the patient, that they’re aware that it’s incompatible with nitrates, and for the doctors in casualties and the doctors in ambulances to ensure that nitrates are not administered to people, and a question is always asked ? are you on Viagra, or have you taken it in the last 24 hours, so that this doesn’t happen?

Liz Jackson:
Nitrates are not just used by patients with heart problems. Amyl nitrate is also used as a party drug and specifically to heighten sexual pleasure. The combination of amyl nitrates for sexual pleasure and Viagra for sexual stamina, has killed young men in the United States. Doctors in Australia know that some of their patients are taking a variety of party drugs with Viagra.

Dr Denis Cherry, Perth Sexuality Centre:
It seems to fit with the risk-taking male behaviour that does occur and particularly at that age-group, you know they just don’t have the consciousness nor awareness of what is appropriate and what isn’t appropriate. And yes, it does worry me and I don’t like the fact that it’s taking place. And certainly, I, if I think there’s any risk of that taking place, I forewarn them about not doing so.

James Price, Product Manager, Viagra, Pfizer Australia:
Q: Is the combination of nitrates and Viagra life threatening?
A: Yeah, definitely can be life threatening.

Liz Jackson:
Pfizer does include a warning for consumers inside the packet that combining Viagra with nitrates may lead to a severe drop in blood pressure which in their words may be difficult to treat.

James Price, Product Manager, Viagra, Pfizer Australia:
Q: Is that an adequate warning?
A: Well I think it is and what you see in that information is approved by the Therapeutic Goods Administration in Canberra, that this is an appropriate warning.

Liz Jackson:
But it’s this report in the September edition of the Medical Journal The Lancet that is the biggest worry for Pfizer. It’s the first fully investigated case study in which a 65-year-old man suffered a severe heart attack, 30 minutes after taking Viagra, referred to by it chemical name Sildenafil. Significantly this was before any attempt at sexual intercourse. His history revealed no diabetes, hypertension or pre-existing heart disease, no previous episodes of chest pain. He took no other medications nor had he used amyl nitrate. The Dutch physicians concluded that this suggests that Viagra was causally related to his heart attack.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
What I thinks important about that case is that GPs don’t know about it.

Dr Phillip Stricker, Urological Surgeon:
Q: What did you think of the recent report in The Lancet, about the Dutch case?
A: I’m not aware of it.

Dr Peter Thompson, Cardiac Society of Australia & New Zealand:
I haven’t read the report, and I don’t know if the interaction that was reported was proven to the satisfaction of the reporting doctors.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
I am confused about some of the things in that report, whether or not the ? what the patient was given nitrates somewhere along that process I’m not sure.
Q: But if it were, as the Dutch physicians found, half an hour after taking Viagra, before commencing any strenuous sexual activity, a man with no previous stroke or other heart vulnerability, had a serious heart attack. They drew the causative link.
A: Yeah, I don’t think they were entitled to draw the causative link. All round the world, men have sudden heart attacks that have been completely well before, and I don’t think they’re entitled to draw the link that the Viagra caused it.

James Price, Product Manager, Viagra, Pfizer Australia:
My advice is that there is no causality, that it might be just a spontaneous case of, you know, who knows what caused that problem.

Liz Jackson:
The product information sheet that goes out to doctors includes a boxed warning ? the first time ever on a brand new drug. Viagra, it says, is contraindicated on men for whom, sexual activity is inadvisable due to cardiovascular risks factors. This is not the wording originally recommended by the Australian Drug Evaluation Committee, they suggested the warning read:
“The use of Viagra in men with cardiac disease has been associated with sudden death.” But after negotiations with Pfizer, they watered it down.

Prof. Martin Tattersall, Chairman, Australian Drug Evaluation Committee:
Q: Did you think that it was useful to use words that drew attention like “sudden death”?
A: Yes, of course. On the other hand, I think we acknowledged on review, that the proof that the sudden death is due to the Viagra as opposed to the physical activity now possible because of the availability of Viagra, had not been established.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
My concern is that because Pfizer have got so much control over the information that goes to doctors, we are getting a rose-coloured glasses version of this, and we’re not getting the information that we need about things like drug interactions, the fact that there’s a possibility of a problem of using this with alcohol, and with some other drugs. We’re not getting that information so we’re not getting the training that we need to use this drug as safely as it could be used if we weren’t being given just this positive spin.

2-Day FM:
This is up close and personal on 2-Day FM. Talk to Tracy Cox by calling 9389 6000.

Tracy Cox, 2-Day FM, on radio:
We’re talking about performance problems tonight and first up is Anna from St Ives. Hi, Anna.

Caller, Anna:
Well, Terry had been having the impotence problems on and off, and slowly getting worse all this year. It makes you not want to speak about things to people because they don’t understand. You try and share that with your best friends, or your family and their reaction is wrong. They would say to me ? look, you’ve got a good life, you don’t have to work, you’ve got a nice home, be grateful for what you’ve got. And I thought is this what I want for the next 20 years? And, Viagra wasn’t here. Now we were one of the first to get this prescription and it has been really brilliant. I want people to know what a good thing it is and stop making fun of it.

Dr Rosie King, Australian Centre for Sexual Health:
In America, there was said to be quite a back-lash where women were saying men need a pill for love, they don’t need a pill for sex. Women were quite angry. And that denies the fact that, in fact three out of four men were happy with Viagra and 50 per cent of their partners were happy with Viagra. Now, I s’pose we have to ask ourselves what about Viagra would make women unhappy? If you’ve never had a good sex life and suddenly your partner comes home like a boy with a new toy, you’re not suddenly going to start enjoying sex.

Dr Bronwyn Stuckey, Medical Director, Keogh Institute for Medical Research:
If you take a history from a woman about her sexual response, then you often get, “well, I’m not interested in sex, I, you know I’ve lost all interest in sexual relationships”. But what’s at the bottom of that?

Liz Jackson:
Pfizer is already exploring this potential new market ? women who’ve lost interest in sex. There are problems with turning older men into born-again potent males, unless their partners are also interested. Pfizer are now conducting international clinical trials on women, including trials in Sydney, Melbourne and Perth, with a view to producing Viagra for women, but it’s early days.

Dr Bronwyn Stuckey, Medical Director, Keogh Institute for Medical Research:
Q: Is it basically the same drug that you’re trialing for women?
A: Yes, same drug, same action, same biochemistry.
Q: But women’s sexual response is so different.
A: Well, the end result is different but the chemical pathway’s which lead to the end result are similar. What else is different is, I think, psychology basically. I think, I, nobody would argue with me if I said that women are infinitely more complex than and complicated than men in assessment of their sexual response.

James Price, Product Manager, Viagra, Pfizer Australia:
Q: In terms of developing this product, who do you see as potentially benefiting?
A: Well, women with sexual dysfunction, I guess, but I mean at this stage we don’t have any patient profile or any sort of details on who will benefit from the product.

In the studio with Tracy Cox, 2-Day FM:
Hi John, how are you?
Caller, John:
I’m very well thank you.
Tracy Cox, 2-Day FM:
Have you ever had a performance problem?
Caller, John:
Well last weekend I couldn’t get an erection. It’s the first time it’s ever happened to me. I was wondering if I needed to take Viagra or something?
Tracy Cox, 2-Day FM:
How old are you?
Caller, John:
I’m 22.
Tracy Cox, 2-Day FM:
Twenty-two. I very much doubt you need Viagra, John, but I’m glad you called because there are a few myths going around about that.

Liz Jackson:
Viagra has proved itself remarkably easy to sell, because performance anxiety is widespread amongst men of all ages. One of the most revealing outcomes from the Viagra trials was that between 20 to 30 per cent of men reported improvement in their erection after taking a placebo ? that is a dummy pill.

Dr Douglas Lording, President, Australasia Society of Impotence Medicine:
Q: Are you concerned that that 20 per cent will now become Viagra takers – that 20 per cent who would have worked just as well taking nothing?
A: It doesn’t concern me that those men will become Viagra takers, because after all, they are presenting with the problem and they haven’t been able to find a solution to the problem, so there is a logic in putting them on Viagra.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
Those people would be much better treated, in my opinion, just with some reassurance, or some simple psychological interventions.

Liz Jackson:
Pfizer’s promotional material sent out to doctors states that a staggering 52 per cent of men over 40 have impotence problems. They prefer to call it erectile dysfunction, that’s a big market.

James Price, Product Manager, Viagra, Pfizer Australia:
We’re really marketing this drug for use in men with erectile dysfunction ? and there’s about 100 million men around the world who could have some degree of sexual dysfunction.

Dr Joe Pollak, Men’s Health Clinic:
But that encompasses men who have a problem maybe once a year. Now, every man over the age of 30 or 35 will sometimes have a problem. And now we’re seeing a tendency to move in the same direction of wide expansion of the medical terminology to encompass women too. I mean, I can see in a year or two, we’re going to hear that women have ? that 50 per cent of women or 60 per cent of men, of women I should say, have a problem with their sexual satisfaction.

Liz Jackson:
Enclosed in the media kit at Viagra’s Australian launch was a five point questionnaire. This was designed, it said, to help you identify if you had signs of erectile dysfunction. The questions asked you to self-assess your potency, from very low to very high, according to five criteria ? your confidence, your satisfaction, how often, how difficult and how long you maintained an erection. If feeling pretty confident about your manhood, you scored yourself high all five questions, and even very high on one. When you added up your point score you still came out as showing signs of erectile dysfunction, such that you should speak with your doctor. This looks like what’s known in the trade as disease-mongering.

Prof. David Henry, Pharmaceutical Benefits Advisory Committee:
Disease-mongering is a term first coined by an American Journalist called Lynne Payer. And it’s difficult to define, but it’s a situation where a test can be performed to try and identify people with a disease or with a medical condition requiring treatment. And depending how you define the range of normal…

Liz Jackson:
Professor David Henry is not commenting specifically on Pfizer or Viagra.

Prof. David Henry, Pharmaceutical Benefits Advisory Committee:
…But by doing the test on them ? screening test on them., by telling them that they have a quote/unquote abnormal result defined in some statistical way, you can perhaps persuade them that they have a medical condition requiring treatment, and that treatment may be an expensive drug which naturally will cost the community a lot, if it’s being subsidised through the community, and represent a very substantial income and profit to companies.

James Price, Product Manager, Viagra, Pfizer Australia:
Q: Do you think that telling four out 10 Australian men that they have erectile dysfunction is disease-mongering?
A: Well, I think it’s highlighting the problem, and as I said, it’s a significant problem with a lot of men with the condition. And as I said, a lot of people don’t seek help or don’t seek treatment and largely it’s the stigma associated with the condition ? taboos for men talking about their sexuality.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
Pfizer are doing the same thing that drug companies always do, almost always do, which is to exaggerate the frequency of the illness, and to exaggerate its severity, so that we are more inclined to be motivated to treat it.

Dr Phillip Stricker, Urological Surgeon:
Q: So what percentage would you predict say, in five year’s time ? what percentage of men in Australia would potentially be taking Viagra?
A: I would predict 10 to 20 per cent based on number l ? the number of impotent men, or erect men with erection dysfunction, and the number of people who may take it for semi-recreational use.
Q: Is that a big burden on the health system?
A: Well…the answer’s obviously yes.

Pharmacist to patient customer:
It’s very important that you’re not taking any nitrates while you’re taking this medication…

Liz Jackson:
The cost of Viagra at the moment varies from chemist to chemist, but it’s between $70 and $80 for a packet of four. For long term regular users, this is expensive. Most of the prescription drugs that we buy are subsidised to some extent by the Government. No decision has been made yet about Viagra.

Frank Latimer:
If the Government and the Health Department are genuine and are concerned about sexual dysfunction in spinal patient, and I’ll just speak of spinal patients, then certainly it should be made available through the hospital or through the sexual dysfunction clinic, and either made free or at a minimal cost to guys that need it.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
The fact that these drugs are going to cost the community a lot of money is a real dilemma for our funding authorities, and they will have to make a decision whether it is reasonable to fund such a quality of life drug.

Liz Jackson:
That decision is due to be made very soon. Pfizer are currently putting their case to the Pharmaceutical Benefits Advisory Committee, which recommends to the Government which drugs should be on the PBS list, put simply, whether Viagra should be subsidised.

Dr Douglas Lording, President, Australasian Society of Impotence Medicine:
I think if it’s not subsidised, what will happen is a lot of people will be denied the option of being treated in this simple way because they can’t afford the cost of the drug.
Q: So yes?
A: So I do believe that it should be subsidised.

Dr Peter Mansfield, GP, Medical Lobby for Appropriate Marketing:
If Viagra does go on the PBS then we’ve got a situation where if Pfizer are able to fool larger numbers of people into using it than really is justified, that they will be effectively be rewarded by the taxpayer for doing so. You know, they get a subsidy that increases every time they get an extra sale, regardless of whether that sale is really worthwhile or not.

Pharmacist to patient customer:
This explains to you how and when to take the actual tablets.

Liz Jackson:
The cost we finally pay for Viagra, will be the result of deliberations, all of which by law are secret, despite the huge implications that any decision will have on how taxpayers’ money is spent The cost of subsidising drugs is already increasing by around $200 million a year, in a climate where the overall spending on health is capped.

Prof. David Henry, Pharmaceutical Benefits Advisory Committee:
I don’t believe that the community, I don’t believe that the medical profession that prescribe these drugs, truly understand that if they prescribe, commonly, very expensive drugs and the costs are that high and increase to that extent, that they’re taking money out of the system that might go to public hospitals, that it might go to aged care, that they’re limiting the capacity of the system to deliver these other programs.

James Price, Product Manager, Viagra, Pfizer Australia:
Q: Have you any idea what that would cost to put it on the PBS list?
A: Well, I haven’t done the mathematics to work it out, but obviously it’s a significant group and funding may be an issue that the PBS look at very closely, I would think.

Alec Thomas:
I can’t see any reason why they shouldn’t be subsidised. And the fact that I’m an ex-serviceman as well, should help the Government, think about the ex-servicemen.
Q: You think they owe it to you to help pay for the Viagra?
A: They said that they owe it to me, when I went to the war. They told me that they would help me and give me as much as they could.

Liz Jackson:
Alec has decided not to try out the Viagra on his wedding night.

Alec Thomas:
Maybe not tonight, because I don’t think you’re allowed to take them when you’ve been drinking, and maybe I might just have drink today.

Liz Jackson:
Alec wants to give the Viagra his best shot, and he knows that confidence is half the trick.

Alec Thomas:
Well you’ve got to have confidence in what you’re doing. So I don’t think about it. I just do it and know it’s going to work, hopefully with, you know, I can add that bit. But, of course, I know it’s hopefully, with fingers crossed. But I’ll wait and see. Perhaps if you want to see me in another week or so, I might be able to tell you if it works.

Liz Jackson:
As it turned out, Alec slipped a disk trying to carry his new bride over the threshold of their marital home. He spent all last week, flat on his back recovering. Maybe next week.