Viagra is now virtually a household word. Perhaps not a word readily used in most households, whether or not it is present in the confines of the medicine cabinet or the sock drawer, but a word that is readily recognised and has developed a strong image very quickly. The little blue, diamond-shaped pill to cure impotence was always going to be what the pharmaceutical industry calls a 'blockbuster' drug.
The phenomenon that is Viagra is an excellent example of what marketing can and cannot do. With a product that is perceived to address a perceived need effectively, the marketing is easy.
In the medical world, impotence is generally known as erectile dysfunction, or EO for short. EO is a condition in which men are unable to achieve an erection sufficient to engage in satisfactory sexual activity. The proportion of men that are affected by the condition is difficult to estimate, as many men are reluctant to visit a doctor about this condition. EO may often have a significant psychological component - that is, the problem is to some extent psychosomatic, or in the mind of the patient. Nevertheless, it is known that the incidence of EO in men tends to increase with age.
Despite men's reluctance to seek help for this condition, it is known that it can be extremely damaging for men, particularly in terms of their self-esteem.
The psychological consequences can be very real, with EO having a potential impact not only on the man's sex life but also on his relationships, his work and beyond. As an extreme instance, the novelist Ernest Hemingway is believed to have killed himself in part because of his emerging impotence.
Treatment for EO presents an interesting marketing conundrum. Products have claimed to be able to treat EO and/or improve a man's sexual potency for as long as markets - and men - have existed. Many of these so-called treatments, such as rhinoceros horn and tiger penis, do little or nothing for the reproduction of the human species and, unfortunately, damage the viability of the donor species. There is thus a clearly existing market, but few effective products.
In the early 1990s, Pharmacia & Upjohn launched a product called Caverject, a drug that could induce immediate erections in men. The main drawback of the product was that it had to be injected - by the patient himself (or by his partner) - directly into the penis. As one doctor said, 'I'd estimate that only about one in ten sufferers will present for EO, and only about one in ten of those presenting will take up the offer of Caverject. They have to be pretty committed.’
Then along came Viagra. The market - in the sense of customer demand - had existed forever, and then along came a new product that could genuinely address the need.
Development of a new product
The compound originally known as UK-92,ABO was developed by the pharmaceutical company Pfizer as a treatment for angina pectoris, a heart condition. The clinical trials for the drug were stopped in the early 1990s when it was found that it was outperformed by existing treatments. However, it was noted that one of the side effects of the drug was marked penile erections1.
As a consequence, Pfizer began clinical trials of the drug as a treatment for EO. The results were very positive and showed that the drug performed significantly better than the placebo. That is, those administered the drug were significantly more likely to report improved sexual function than those who were given a placebo2.
Sildenafil is the generic name of the chemical compound that is more widely known by the brand name Viagra. Sildenafil is a phosphodiesterase-5 (PDE-5) inhibitor and operates by facilitating the flow of blood to the penis, thereby allowing the male to respond to stimulation. It is important to note that sildenalfil isn't an aphrodisiac. It...