Penile undermarketing

Posted on September 6, 2008. Filed under: Everything you wanted to know about doctors, Medical marketing, Sexual issues |

Alert blog-reader Moshe has asked the question: “If these penile implants you’ve talked about are so wonderful, how come I haven’t heard much about them?” You know, Moshe, I’ve been asking that same question since 1975, when I scrubbed in for my first inflatable penile prosthesis (IPP) operation. The result was so impressive that the female scrub nurse (unmarried) remarked, “Can you get me a list of men who have these things?” She wasn’t referring to size; the finished product was no bigger than the original. What she saw was control: comes up when you want it to (no matter how drunk the guy, nor how ugly the girl), stays up ’til everybody’s happy (or at least finished). The most urgently anxious patient I ever had was a widower in his 70’s who had just married a similar-aged widow. “Doc,” he begged, “I just got to get me one of those transplants (sic) right away: I just found out her late husband had one!” Ah yes, tough competition there.

Even young, healthy people with no signs whatever of joint disease are well aware of artificial hips and other joints; those with no heart disorder of any description are cognizant of artificial valves; everyone with adequate vision is aware of breast implants. So, why is the IPP America’s best-kept secret?

For almost everyone I’ve encountered, the answer falls into one of two categories:

  • ignorance of the product, or
  • misunderstanding about the product

The responsibility for these two situations rests squarely at the feet of one entity: the manufacturers. This should be a very surprising observation, given all the negative publicity surrounding the over-marketing of products by big pharma and medical device companies, as discussed here, here, here, and in a series of posts by Dr. Robin Hanson on Overcoming Bias. OB seems an appropriate mention at this juncture, since the under-marketing of IPP’s is a blatant example of carrying bias to the extreme, even to the point of harming one’s own business. And what bias is that? A two-fold one against older men having sex in general, and against the portrayal of the penis as a normal component of humanity’s make-up in particular.

I well remember when FDS, the brand name chosen for feminine deodorant spray, both invented the need for such a product, and plastered it all over the magazines and television. I’ve been seeing tampon and “feminine napkin” ads since long before I knew their purpose. But a legitimate treatment that makes a “sick” penis “well”? Haven’t seen much of that, have we?

To illustrate the blatancy of this bias, herewith: the original manufacturer of the IPP, American Medical Systems, was purchased by Pfizer in 1985. The IPP was “marketed” by Pfizer until AMS was sold in 1998. When I visited Pfizer headquarters in the mid-90’s, their Park Avenue lobby had a display case for each of their many divisions (which in those days involved far more than just drugs), including the Howmedica orthopedic appliance division, the ValleyLab medical electronics division, the veterinary and agricultural divisions, and others. Noticeably absent was the display for the penile prosthesis division, which controlled about 80% of the market. While I never met Chairman Bill Steere, other executives told me that he did not feel such a product was in keeping with Pfizer’s image (BTW, he had the same opinion when Viagra was first presented to him, but he was swayed when the bean-counters mentioned the $2+ billion annual revenue). As a result, he marketed the IPP under a “grandfather” clause in the Food, Drug, and Cosmetic Act that allowed devices already on the market prior to 1976 (IPP’s were) to be “cleared” rather than “approved” (see this). Under this clearance status, IPP’s could not be marketed directly to the public, which suited Mr. Steere just fine. Patients could find out about the devices only from urologists, previously-implanted patients, stand-up comedians, feminist hate-groups, and urban legends.

AMS, and it’s only IPP competitor, Mentor Corporation, could have applied for “Pre-Market Approval” status for their devices, simply by performing the clinical studies required by the FDA. SInce the product was already on the market, it would have been quite a simple task (and in fact, it now has been done, albeit with no change in the marketing philosophy). But Mr. Steere was not the only chairman with a bias. Mentor’s founder and lifelong (until retirement) chairman, Christopher Conway treated me to dinner at the San Ysidro Ranch (known as JFK’s honeymoon spot) in 1990 (or so). I had been telling him in back-and-forth communications that the Council on Aging’s estimates of fewer than 2 million impotent American men seemed woefully lean; my own numbers from our smallish town extrapolated to a national figure of 40 million men. On the occasion of our dinner, I mentioned that the Massachusetts Male Aging Study (concluded in 1989) indeed came up with the same figure I had suggested: 40 million impotent men between the ages of 40 and 70 (and many more millions above that age, but that’s another post). Mr. Conway did not even miss a bite, as he observed: “There may be 40 million instead of 2 million, but almost none of them would want to have a penile implant.” Then we had dessert.

Unless you’re one of two particular people alive in the world today, you’re not the chairman of either of the IPP companies. But I bet you can come to a better conclusion than they have, no matter who you are. Let’s look at some facts.

In 2007, in the USA alone, almost 400,000 women underwent cosmetic breast augmentation (implants). Insurance did not pay for any of it; the women plunked down their own 5-20 thousand dollars. For their money, they did not restore any normal bodily function, and they did this in spite of widely publicized warnings of dangers (scientifically unfounded, of course, but most of them don’t know that) associated with the procedure.

Since 1973, about the same number of men (~400,00) IN TOTAL have received IPP’s. During that time, it has been covered by Medicare (whether or not one agrees with the propriety of same) and most 3rd-party insurance policies. For a man on Medicare, with an inexpensive supplement, it’s free. Provided he has a cooperative partner, it makes it possible for him to have sex anytime they wish, for as long as they wish, and the alternative is no sex at all. Do you think there is a market for that? (Pro-tip: if your answer is “no”, you may be qualified to be the CEO of a penile prosthesis company. Corollary to pro-tip: by the time healthy CEO’s are old enough to need a penile prosthesis, they have already retired).

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7 Responses to “Penile undermarketing

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I’m glad to see you’ve kept up your blogging!

Thanks. The Web is tough, especially readers from OB.

Old people having sex is too disgusting to think about. And penises are no picnic. I’d rather not even see my own in the mirror, and we all know that our farts smell better to us than anyone else’s. Sticking an implant in there just sounds inherently painful though I’m sure you knock the patient out with sleeping gas. So that’s my knee-jerk reaction.

So, are these things useful for premature ejaculation?

@Doug S

“effective” in the sense that the penis remains erect after ejaculation, until the man chooses for it go down. “Not effective” in terms of increasing ejaculation latency. Pro-tip: men are not able to test their ejaculatory refractory period by vaginal intercourse unless they are able to achieve (or maintain) the erection.

That said, it would be entirely unethical for a surgeon to perform an IPP operation on a healthy man, simply because of premature ejaculation. However, I would not be surprised if I learned that purely “elective” IPP ops have occurred, comparable to breast augmentations. If you get rid of ethics, good judgement, and lawyers, there’s a lot of money to be made in a lot of fields.

Later today, I plan to post on premature ejaculation. Get your tickets early: they’re going fast (a little PE humor there).

Are said implants any more dangerous than breast augmentation? 😉

(Viagra has seen plenty of use by people who don’t, strictly speaking, need it.)

@Doug S

There’s a big difference between a pill that enhances performance temporarily, without causing any permanent tissue changes, and an internal device that alters the anatomy and physiology of the penis. If an implant ever were to be removed and not replaced, there could never be another erection. Removal of breast implants, for whatever reason, may leave a woman misshapen and unhappy, but it does not affect a bodily function. Consequently, the only man who should take the risk is the man who has no erections to lose.


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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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