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South Africa: Little Blue Pill Started a Revolution
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Business Day (Johannesburg)
27 March 2008
Posted to the web 27 March 2008
Tamar Kahn
Johannesburg
TWENTY years ago, resear-chers at drug firm Pfizer ran into a puzzling problem when some of their volunteers, testing a potential new angina drug called Sildenafil Citrate, seemed strangely reluctant to part with their unused pills when the experiments ended.
It turned out that the pills had some rather enjoyable side-effects for male volunteers who had been battling with impotence; it gave them stronger erections.
And thus, Viagra was born -- the little blue pill that, in the 10 years since it was approved by the US Food and Drug Administration, has revolutionised the way we talk and think about men's sexual health.
Viagra was the first oral treatment for impotence, or "erectile dysfunction" and rapidly replaced clumsy, if effective, pumps and injections. It was discreet, it was readily available on prescription, and it was marketed with the appealing message that erecti le difficulties were due to an underlying physical problem. Until then, many men had been told their problems were most likely in their heads; the product of unresolved psychological issues or neuroses.
"Viagra took the discussion about male sexuality out of the shadows. A subject that was taboo, became treatable," says Pfizer's head of legal services for southern Africa Matthew Moodley.
Worldwide, about half of all men older than 40 have some degree of erectile dysfunction. While psychological issues such as anxiety certainly play a role, for many men, the trouble simply lies with a condition that affects blood supply to the penis, such as cardiovascular disease, diabetes, hypertension, or even prescription drugs.
"Viagra has been a sexual revolution, an incredible gift to men and their partners," says Marlene "Dr Eve" Wasserman, a clinical sexologist in private practice who runs education workshops for Pfizer. "It has brought huge attention to the issue of erectile dysfunction and made it acceptable to talk about sexuality," she says.
Pfizer's Viagra was swiftly followed by similar products from Eli Lilly, which markets Cialis, and Bayer, which sells Levitra. All three dilate the blood vessels in the penis to increase blood flow. They do this by inhibiting an enzyme called PDE-5, which allows a chemical produced during sex, called cyclic GMP (cGMP) to persist. The longer c GMP sticks around, the better the chances of more blood flow, and an erection.
All three companies have campaigned hard to drive home the message that sex is a vital indicator of overall health. "If there is an erection problem, it is often an indication of something else," says Bayer Schering Pharma's men's health manager Estie Beukes. She says 64% of men with erectile dysfunction have hypertension, dyslipidaemia (high cholesterol) or diabetes.
The success of the drugs has spawned a massive global counterfeit industry, centred in Pakistan, India, China and Eastern Europe, that has dented sales of the real thing. Many men are willing to try a cheap knockoff, or the plethora of unproven herbal remedies that promise a night of unrestrained passion, says Eli Lilly marketing director Jacques Blaauw.
The prescription pills do not come cheap: a pack of two tablets of the lowest dose (25mg) Viagra is sold to pharmacists at R96 excluding VAT, and consumers can expect to pay an additional markup of up to 35%. Cialis and Levitra are at a similar price. Medical schemes are reluctant to foot the bill for impotence medication, even for patients with underlying chronic diseases such as diabetes.
Lost sales due to competition from counterfeit and herbal products have been compounded by tougher economic conditions in SA, which have left consumers with less disposable income, says Blaauw.
"Sales of erectile dysfunction drugs follow the trends for consumer products -- we always see a rise in sales during the holidays," he says.
The downside of Viagra and its companion drugs is that they have led many men to have unrealistic expectations of sexual fulfilment, says Dr Nevon Ramsunder, director of Men's Clinic International.
"We have younger people with no underlying problems using them for recreational purposes. If they're getting normal erections, Viagra won't make them any stronger and the drugs can have side effects, such as hot flushes and palpitations," he warns.
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The other danger of the pills is that they may lead people to neglect other aspects of their sexual relationships, says Wasserman. "A drug alone is not going to make the magic," she says.
As is so often the case with the company that is first to market with a new class of drugs, Pfizer led the way in convincing doctors and the public that sexually inactive men had a simple dysfunction that could be corrected.
Its rivals swiftly capitalised on Pfizer's marketing efforts, and it now commands just a third of the R110m South African market for erectile dysfunction prescription medication. Cialis is the market leader, with about half the sales.
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