Thursday, 7 December 2017

Sex, Drugs and That Little Blue Pill

Viagra History From Sex Icon to Generic Drug

On Monday, a generic drug company is going to begin selling sildenafil in the U.S., and to tell you the truth, I’m surprised the news hasn’t gotten more attention.

Marketing pitch.
 Source: Bloomberg

You see,  is the compound that goes by the brand name Viagra. Introduced by Pfizer Inc. in March 1998, Viagra has generated over $17 billion in the U.S. alone. Although the Viagra patent doesn’t expire until 2020, Pfizer agreed about four years ago to allow Teva Pharmaceutical Industries Ltd. to sell a generic version starting in December 2017, settling a legal battle between the two companies. 1
But Viagra’s patent history is hardly the point, is it?
Viagra was the first drug to allow impotent men to maintain erections. That made it the first true “lifestyle” drug and showed the pharmaceutical industry that there was money to be made developing drugs that improved people's lives without curing disease or alleviating pain. Its advertising — happy couples enjoying life thanks to Viagra (with the drug’s side effects read hastily as music swells) — was a precursor to the direct-to-consumer pharma advertising that now assaults us daily.
Although its critics have often decried Viagra as representing a degradation of American life — a descent into “a quick-fix pill culture," as one author put it 2 — there's no denying that it has allowed millions of men to reclaim their sex lives. And thanks in part to the way Viagra and its eventual competitors, Cialis and Levitra, have been marketed, it’s also been used by millions of men with little or no need for it at all.
The 1990s, when Viagra was first brought to market, was the era of the pharmaceutical blockbuster, defined as drugs that generated $1 billion or more a year in revenue. At the time, Pfizer had Lipitor, Celebrex and Zoloft in its portfolio. Sildenafil was expected to join them — as an angina medication. Alas, trials showed that the compound didn’t do much for angina, 3 but it had a remarkable side effect: With very little arousal, men got sustained erections.
This did not cause Pfizer’s top executives to jump for joy. In that more sedate age, they worried about being accused of selling a recreational drug. They feared that the company’s reputation would be besmirched by manufacturing a sex aid. They even toyed with the idea of spinning Viagra off into a separate company, as a way to keep its new drug at arm’s length.
But after conducting marketing surveys and focus groups, Pfizer became convinced that Viagra was destined to become another blockbuster. (Indeed it was: It hit the $1 billion mark in its first full year 4 on the market.) So instead of distancing itself from its new drug, Pfizer went all in, cooperating with stories it knew would be more salacious than not.
If creating a lifestyle drug was the first innovation, selling one was the second. Traditionally, companies sold drugs by having salespeople persuade doctors to prescribe them. But that wouldn’t work for Viagra; doctors were as reluctant to ask patients about their sex lives as anyone else. The only way doctors were going to prescribe Viagra in large quantities was if patients asked for it.
Luckily for Pfizer, the year before Viagra was launched, the U.S. Food and Drug Administration agreed to allow drug companies to advertise on television. No company used this new form of advertising as shrewdly as Pfizer. Its first ads featured Bob Dole, then a 75-year-old former Kansas senator and war hero who had run for president in 1996. Dole’s task was to show that he wasn’t embarrassed to discuss his own impotence, the result of prostate cancer, and that others shouldn’t be either.
He also popularized the phrase “erectile dysfunction,” a term that suggests that with the right medication, what is dysfunctional can become functional. And he encouraged men to talk to their doctors about the condition. 5 Many doctors who remember those days say that men would bring up Viagra sheepishly, just as the visit was wrapping up. Still, they asked. According to one survey, 33 percent of the men who saw a Viagra ad in those early years brought it up with their doctor.
It wasn’t long before Dole’s work was done, and he was replaced by a series of sports stars like Pele, the soccer great, and the baseball slugger Rafael Palmeiro. They sent the message that your masculinity would not be besmirched if you needed a drug to get an erection — and, just as important, that you didn't have to be part of Dole’s World War II generation to benefit.
In 2003, Eli Lilly & Co. introduced its own erectile-dysfunction drug, Cialis, and Bayer Pharmaceuticals came out with Levitra. That year, Viagra hit $1.9 billion in revenue. Then sales dropped the next three years, as Cialis and Levitra stole away market share. For all three companies, but especially for Pfizer, the game became expanding the market by getting the drug to men for whom impotence wasn't a major problem.
And so, little by little, certain self-imposed cautions were swept away. Doctors talking about erectile dysfunction gave way to happy couples and swelling music, which gave way to, well, “mastery.”
At least that’s how Jennifer Zimmerman, the chief global strategy officer at McGarryBowen, described her advertising agency’s approach when it had the Viagra account between 2009 and 2013.
“When we took a look at the business,” she told me, “we saw that there was a fundamental issue with people looking at this as dysfunction. We thought you should look at it through the lens of mastery. Either talk about the one thing that isn’t working so well, or acknowledge all the things that are working well as a point of contrast.”
When the agency pitched the business to Pfizer it used the tagline: “This is the age of man. This is the age of Viagra.”
Today, the market has indeed expanded; taken together, Viagra, Cialis and Levitra generate more than $5 billion a year. The market will expand even more once generic Viagra is available. Cialis, too, is going off patent soon, and Lilly is expected to try to get it approved as an over-the-counter drug.
Men with medical problems take erectile dysfunction drugs, 6 but so do college students on spring break who want to make sure their alcohol intake doesn’t impair their ability to have sex. No one tries to disguise the fact that expanding the market has turned Viagra into a recreational drug, the very thing Pfizer once feared.
A few years ago, when I was thinking of writing a book about Viagra, I interviewed a few old Pfizer hands, people who had been present at the creation. They exhibited great pride in having helped birth Viagra, but they were also touchy whenever I said anything that suggested that sildenafil was anything other than a medical breakthrough. But they seem to be the only ones who still care.
That includes Pfizer itself. In recent years, its ads have thrown caution to the wind. One shows a young woman laying stomach-down on a bed, her bare feet swinging in the air as she gives a come-hither look. Another shows a woman in a football jersey sitting on a hotel bed tossing a football in the air. The ad ends with her walking to a big window, and opening the shade in a manner so suggestive you can’t possibly miss its meaning.
Over the years, sex has gone from being a largely private matter to something that is constantly in our faces. There are many reasons for the transformation, from the social upheavals of the 1960s to the introduction of the birth-control pill to the changing conception of aging. Somewhere in the march of progress, if that's what it is, Viagra and its marketers played a role.
Then again, maybe I’m overthinking the whole thing. I once asked a psychiatrist of my acquaintance why he prescribed Viagra and why he thought the drug was so popular.
“Because it works,” he said.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
  1. 1.Teva will pay Pfizer a royalty on its Viagra sales until April 2020, when other generic manufacturers will also be able to sell the compound.
  2. 2. “The Rise of Viagra: How the Little Blue Pill Changed Sex in America,” by Meika Loe
  3. 3. Years later, sildenafil was approved for heart problems as well. It is especially useful for lowering elevated pulmonary pressures that prevent blood from getting to the lungs of newborn babies.
  4. 4. It also surpassed Lipitor for the highest number of prescriptions in its first week in pharmacies.
  5. 5. Dole once told me that he agreed to do the ads on the condition that he didn’t have to mention Viagra by name. “I don’t know why I insisted on that,” he said. “Seems kind of silly now.”
  6. 6. One man who could have really used Viagra was Frank Sinatra. By the early 1980s, he was impotent, which he tried to fix with the only available remedy at the time, penile implant surgery. But as James Kaplan recounts in “Sinatra: The Chairman,” the second volume of his magisterial biography, the implant failed “because Frank tried to use it too soon.” When Kitty Kelly published her salacious biography of Sinatra in 1986, suggesting he had had an affair with Nancy Reagan, his wife Barbara was unworried, knowing that her husband was physically incapable of having an affair.