“How ya like me now?” he asked stiffly …

Posted on August 26, 2008. Filed under: Medical marketing, Sexual issues |

Since the “little blue pill”, the question that seems to be on everyone’s lips is, “What about these phosphodiesterase-5 inhibitors?” Right? Here’s someone inquiring, even as we speak. PDE-5’s inactivate one of the chemicals that makes erections go away (yeah, I know it seems that the verb should be “make” instead of “makes”, but that’s because the subject “one” is hidden by the prepositional clause “of the chemicals”; trust me: I went to school on an English scholarship). Male sexual arousal produces a chemical to initiate erection, and unless opposed, erection is maintained. Eventually, the almost non-flowing blood in the erect penis would clot (priapism), and without rapid treatment, probably no other erections would ever occur. Clearly, animals whose penises worked in this fashion were eliminated by natural selection. In those of us who have evolved long enough to be reading this blog, male arousal produces, along with the “get it up” chemical, a “get it down” chemical. When arousal is adequate, the former exceeds the latter. Eventually, e.g., after ejaculation, or when boredom replaces curiosity, or when the kid says, “What are you doing to Mommy?”, or when the prolonged friction has produced near-toxic levels of latex vapor emanating from the girlfriend’s woo-woo, or the Super Bowl is starting, the production of the “up” chemical slows, and the “down” chemical takes over. In the case of ejaculation, epinephrine production hastens the decline. If you want to know the exact technical aspects, check this summary.

But that’s not what I’m here to talk about. I want to explore the marketing of these miracle pills (there are three brands in the US). Bob Dole’s radical prostatectomy operation was widely publicized. He was a prominent public figure, just having run for president (of course, I’m not suggesting he was as recognizable as a movie celebrity, but he was available, and Libby was becoming impatient). Somehow, even the people who did not realize that Britney Spears was not the Secretary of State seemed to know that radical prostate surgery leaves you with less than a full load of lead in your pencil. Alertly, the people at Pfizer recognized that fact. Bob appeared on TV and in print media without shame, confessing his loss of manhood and rejoicing in the erectionality that Viagra had returned to him. Right?

Not exactly. He never mentioned at all that he suffered from ED, nor did he say anything at all about Viagra being helpful for ED. He just mumbled something about seeing your doctor if you have health problems. How could that sell anything? Well, at the time, the number-one most recognized product name in the world was Coca-cola. Number-two was Vitamin V. Pfizer didn’t need to tell people what Viagra was for, any more than Coke has to explain how drinking soda unites nations across the world. You see an ad for Coke, you want one (or maybe a beer). You see an ad for Viagra, you start thinking, “Hey, I could watch Laverne and Shirley re-runs some other time!” 

And it worked. Because of patent-timing and FDA applications, Viagra had no competition for the first two years. In 1993, before word began to leak out generally about the little angina pill that could, Pfizer stock was cruising along at about $65 a share. Shortly after the English cardiologists reported the reason for their angina-study patients wanting more of the trial pills, at the 1994 VI World Meeting on Impotence, in Singapore (I was fortunate enough to discuss all the details with the investigators at dinner), Pfizer stock began a precipitous climb (appropriate, no?). Between then and 2001, the original $65 share split 12 for 1, and was back at $43, the equivalent of the original share being valued at about $750, a cute little 1150% return in seven years. In 2002, knowledge of the successful trials of Levitra and Cialis started Pfizer on a gradual decline from which it has never recovered, closing today at $19. But look at those billions in the meantime!

Bob Dole was a part of the pre-competitor Viagra strategy. It took advantage of a loop-hole, of sorts, in the FDA regulations about direct-to-consumer pharmaceutical ads (show your age: do you remember when the only place you could get information about prescription drugs was from your doctor or pharmacist?). If you don’t make a claim about what the drug does, you don’t have to give any of those pesky lists of precautions. I’m sure you’ve seen the TV ads where the list of what-if’s goes on far longer than the description of the intended use of the drug; surely you didn’t think the manufacturer was doing that just be balanced? They do it, or they can’t run the ad. Well Bob never said what was wrong with him, and Bob never said what the drug treated, so Bob didn’t have to mention anything at all about interaction with nitrates and alpha-blockers, changes in color perception, loss of vision, priapism, facial flushing, Viagra-induced divorces, etcetera. 

When Levitra was approved in early 2003, they tried the same approach. Duh, it didn’t work, because no one had ever heard of Levitra, nor had any idea about its intended use. Remember the athletic-looking guy, throwing the football through the hanging tire? His performance had really improved since taking Levitra. Most people I knew thought it was for treating arthritis, or some sort of shoulder inflammation.

When Cialis came out, they went straight for the message, “Take this drug, and you’ll be able to screw all weekend.” **Note to advanced readers: Cialis was released first in Europe; it’s nickname in France was “le weekend”.** Of course, such a claim necessitated enunciation of all the negative possibilities. If you think you are clever, look what these guys did; they took the lemons and made lemonade. All the side-effects and precautions were mentioned, but most prominently emphasized was the risk of priapism. How often since have you heard, “In the event that you have an erection lasting more than four hours, be sure to call your doctor.” Since people don’t know about the real dangers of priapism, this seems like a tongue-in-cheek warning against having too much fun. As one old Cajun man told me, “Hell, if I have a hard-on that lasts more than four hours, I’m not callin’ my doctor. I’m callin’ CNN!”

Pfizer struck back with an ad full of nuance, you know the one showing the handsome, white-haired stud out with his woman for the weekend on his Harley, with all sorts of sexual innuendoes? Well, that was the end of the free ride for Viagra. The FDA said it it was obviously meant to suggest that the drug improved your sexual performance, so come on down! with your list of complications.

And you thought silly putty was a great invention.


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    The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.


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