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Outsmarting the Mainstream Medical Profession

Initially tested as a heart medication due to its vesseldilating properties, sildenafil citrate was found to have unanticipated repercussions in male trial subjects: it effectuated erections. The compound’s manufacturer, Pfizer Pharmaceuticals, named the compound Viagra and evaluated its efficacy in numerous randomized, placebo-controlled trials involving more than 3000 men with varying degrees of impotence associated with diabetes, spinal cord injury, history of prostate surgery as well as those with no identifiable organic causes of ED (United States Food and Drug Administration Website, 1998). Unlike previously approved treatments for erectile dysfunction, Viagra was not found to cause penile erections directly, but to instead affect the man’s response to sexual stimulation. By enhancing the smooth muscle relaxant effects of nitric oxide, a chemical normally released in response to sexual stimulation, the drug enhanced smooth muscle relaxation which allowed for increased blood flow into certain areas of the penis, leading to an erection. The FDA announced the approval of Viagra on March 27, 1998, while Health Canada’s approval came on March 8, 1999. In the United States, Viagra quickly became that country’s best-selling prescription drug ever, with 7 million prescriptions written by mid-December of the same year (Canadian Medical Association Journal, 1999). The initial approval of Viagra in the United States, as well as its perceived ability to ‘restore’ malfunctioning masculinities, resulted in unprecedented demand for the drug internationally (Potts et al., 2004). In 1998, a road connecting Canada with upper New York State was dubbed the “Viagra Highway” due to the number of Canadians crossing the border to buy the drug (Canadian Medical Association Journal, 1999). Within a few months of its release, Viagra and the phrase ‘male erectile dysfunction’ became household terms, penetrating news and multimillion dollar advertising campaigns, allowing the previously hidden, taboo-like health and socialproblem to surface along with its accompanying questions. Men were made to feel that it was acceptable and common to have this ‘dysfunction’, especially since they would no longer have to “suffer in silence”, seemingly alone: Erection problems are very common, and are now understood to be a real medical condition that can be treated. Many men are suffering in silence when all they need to do is talk to their physician. (Pfizer pamphlet, 2000) The marketing campaign and efficacy of Viagra propelled its sales to 50,000 prescriptions filled per month in Canada in 2004. In addition, within five years of Viagra’s launch, the drugs Cialis and Levitra, both working similarly to Viagra, also entered the men’s market. In 1997, the American Urological Association’s newsletter Urology Times forecast that urologists would see a new field of medicine “explode” in the near future (Loe, 2004). This undoubtedly came to fruition, with these advancements creating a giant new product category for the pharmaceutical industry – nicknamed the ‘sexuopharmeceuticals’ (Tsao, 2004; Potts et al. 2004). During this time period however, the previously changing balance of power between physicians, consumers and pharmaceutical corporations became not only evident, but also exploited by both consumers and the pharmaceutical industry. The approval of Viagra was accompanied by extensively advertised claims that large numbers of men were suffering from erectile difficulties and seeking treatment. In media campaigns and advertisements, the slogan “talk to your doctor” hinted of Pfizer’s continual encouragement of men to visit their physicians in order to inquire about ED and its accompanying treatment. After all, a man in a medical office inquiring about Viagra is more likely to receive a prescription than one who does not address the issue at all. This approach centred on delivering potential customers to the ‘gate-keepers’ of Viagra sales, the physicians, who ironically also stood to profit from such urgings (Conrad and Potter, 2000).

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