Washingtonpost.com: Viagra Report

Thanks to Viagra, they say, Alfred Pariser, 58, of Rancho Mirage, Calif., and his wife, Cheryl, 53, now can have sex "sometimes two or three times an evening." (By Douglas Park for The Washington Post)

"What you're really seeing is unbelievable interest in this drug, and it's telling us something about our culture," says internist Steven Lamm, who teaches at the New York University School of Medicine. "A lot of men are unhappy with their sexual performance."

Not Alfred Pariser, 58, of Rancho Mirage, Calif. A survivor of severe prostate cancer, Pariser says he tried a passel of other potency-promising methods before signing up for the last available space as a subject in the Viagra test. "It really, really works," he says.

His wife says the drug, which costs about $10 per dose, has turned him into Tarzan. Pariser says he now has sex "as often as I can . . . sometimes two or three times an evening."

If Viagra isn't the prize, the next potency pill to come from a drug company lab will be. Or the next. Viagra has demonstrated that there is a Mighty-Joe market for orally administered manliness. Telephones in urologists' offices are beeping almost nonstop.

"This is just the beginning," says Lamm, author of "The Virility Solution," a study of potency to be published next month. "This is blunt treatment."

Blunt but not dull. If nothing else, Viagra is raising a multitude of questions: What will it do for men who are not impotent? What does it mean to be impotent? Or potent? If the drug measures up to its hype, will bedroom politics ever be the same again?

Publicly the company is playing down the idea of potent men using Viagra as an additional stimulus. "We have no plans to conduct tests on potent males," says Pfizer spokesman Andy McCormick. "We don't think it's a performance enhancer."

"We're going to be moving away from what we consider normal to what is considered ideal," Lamm says.

Some Side Effects

According to Pfizer's tests, 70 percent of the more than 4,000 impotent men tested worldwide had positive results. Potential side effects include headaches, indigestion and facial flushing and, for some strange reason, an inability to distinguish between green and blue.

Doug Hammonds, 44, an aircraft mechanic in Mesquite, Tex., says he could not figure out the cause of his problem. His urologist prescribed Viagra when the drug first became widely available a couple of weeks ago. "I swear by the stuff," he says.

Before having sex with his wife, Hammonds pops a 100 milligram pill into his mouth. And everything works fine. He has experienced some headaches. "I just take a couple of Tylenol and they go away," he says.

Viagra has also reinvigorated Charles Cate, 59, a retired Wal-Mart employee in Rogers, Ark., who has undergone a heart bypass and radical prostate surgery and is a "borderline diabetic."

"I'm single, but active," he says. He's been dating the same woman for more than a year. Viagra, he says, works like a charm. He uses it every night.

His success has affected every aspect of his life. The drug, he says, has made him feel like a whole man again. "You feel like you can compete with anybody . . . like you're middle-aged again, 30 or 40 years old."

He says, "You can go out and be more active. Psychologically it really clears your mind." His girlfriend, he says, "rates it a 10."

Will such stories alter the definition of potency? And increase the level of performance anxiety?

Shauna Farr-Jones, a biotech researcher in San Francisco, is married to a doctor who has prescribed Viagra in his primary-care medical practice. She is also a member of a women's investment club that monitors biotech stocks such as Pfizer. The group has not only discussed the drug's financial potential but its social aspects as well. "We've talked about how it will be really good for older men and people with diabetes," she says. "Their wives will be happy."

And what about the healthy guy who envisions becoming a high-strutting stallion for a night? "If it doesn't have bad side effects," says Farr-Jones, "I don't see a problem with that. I bet Pfizer would be thrilled."

Like a national truth serum, the little blue pill also has begun to open up discourse among men and women about triumphs and failures between the sheets. Formerly obscure phrases such as "erectile dysfunction" and "urethral suppositories" are showing up in popular parlance.

It wasn't so very long ago that our society choked on words like "masturbation" and "orgasm." The birth control pill changed that. Not only did it prevent pregnancy, it wiped out some euphemisms. Check out a Cosmopolitan magazine at the local supermarket.

And "the pill," as it was called (befitting its first-in-line status), made it acceptable to talk about -- or, by some lights, engage in -- casual sex. Serotonin reuptake inhibitors, such as Prozac, made it all right to discuss depression without shame. Ritalin was a way to talk about out-of-control kids. Viagra, or its offspring yet to be born, could make sexual dysfunction just another treatable malady.

When taboos are cracked open, the world changes -- not only for the taboo busters but for the rest of us as well.

The arrival of Viagra could rival the impact of the birth control pill, which hit the market about 40 years ago. With the same generation as beneficiaries.

There is a difference: The birth control pill transformed the baby boomers at the beginning of their sexual lives. Viagra comes at the latter stages. But the upshot could be equally powerful. The birth control pill eliminated one undesirable outcome of extramarital and premarital sex -- pregnancy. (Leaving disease and eternal damnation still to be reckoned with, of course.) The definition of a "good girl" became more fluid. Unmarried women were able to engage in sexual intercourse more freely.

The promise of Viagra, on the other hand, is the obliteration of the physiological and psychological obstacles to performance. For a society that has operated under the construct that people in their fifties and sixties are physically in decline, less interested in sex, less capable of performing, more preoccupied with jobs and careers than with sexual pleasure, this could redefine an entire stage of life.

A Subtle Influence

Will some men develop a dependency on Viagra? Will some women develop a dependency on men on Viagra?

It would be a shame if the use of Viagra means that the body or the mind becomes dependent on it, says George Leonard, a pioneer of the human potential movement and author of a shelf of books including "The End of Sex: Erotic Love After the Sexual Revolution."

Leonard abhors "quick fixes" in society. "I feel strongly that big changes in someone have to do with lifestyle," says Leonard. He believes that people with impotence problems need a total make-over -- of their behavior, their diets, their exercise regimens, the way they look at life and at other people. "The mind is such a powerful part of pharmacology," he says.

"I don't think that Viagra in any way denigrates love, affection, romance," he says. But when he brought up the subject with a couple of female friends, the women were taken aback.

"They want love to be involved," he says. "I tried to assure them that in order for the drug to work, you have to really care, you have to see a little love light shine first."

Eileen Palace, director of the Sexual Health Clinic at Tulane University, has done research for Pfizer and is concerned that people might misunderstand Viagra. "People today expect things to happen on demand," she says. "You can't make sex happen on demand; it's not a fax. Penises are actually very good barometers. They are indicators of what is happening in a relationship."

The pill should not be used without therapy, she cautions. "It's much more likely to be effective when you combine the psychological and medical treatments."

Confidence Builder

He sees the potential for misuse. "I can imagine college kids saying, 'Hey let's have a Viagra party.' "

Though Pfizer is quick to point out that Viagra is not addictive, Caplan says that some people could become psychologically dependent on the drug, and it may not be unusual in the near future "for a man in his fifties or sixties to carry a pill like he did a condom when he was younger."

Is such a cavalier attitude good or bad for the male of the species? Caplan says, "It's not bad to take Viagra. But it is bad if you think the only way to have sex is by taking a pill.

"The best protection we've got," he continues, "is for the doctors who prescribe it to fully understand it. But in the end we'll probably see more people using the drug than need the drug."

Because many people will believe it is an aphrodisiac and that it will inspire confidence, says Caplan, "some people will use bigger doses than they should." Pfizer recommends only one pill per day.

"The typical American attitude is that more is good," Caplan says. "I'm sure we're going to see some people abuse the drug. We can anticipate a black market. This stuff isn't that difficult to make."

Barring some unforeseen glitch, Viagra will be at the center of our national sexual debate for some time to come. It's possible that men -- and women -- of all ages will experiment with the pill in various ways.

But unlike almost any other treatment, men and women will need each other for the cure. Or, in the case of gay men, a partner of the same sex. Of all the health issues facing men, impotence is the only one that also directly affects another person's body and sexual gratification.

The support of women is critical to the success of Viagra, and Pfizer discussed early on that it would probably do its first mass advertising in women's magazines. "It's a couple's condition," says Pfizer's McCormick. "The partner is often involved in making the choice. In fact, with men who get treatment for erectile dysfunction, eight out of 10 consult their partners. Women in general tend to be more involved in health decisions."

From one angle, Viagra is just one more aspect of boomers refusing to grow old. It's the Ponce de Leon drug.

"With baby boomers aging," says Caplan, "there will be a big market for this drug." He predicts that Viagra will "sweep past" existing treatments such as injections, suppositories and vacuum pumps. There may be an even bigger market: Pfizer has just begun tests to determine the effect of Viagra on women.

If medicine can help people keep hair, tone muscles, prevent breasts from sagging, why not a drug that enables erections? Why shouldn't doctors be prescribing it to just about anyone who asks for it?

Practitioners like Steven Lamm are wrestling with questions like that. "Impotency is not a life-threatening disease," he says. "What is my mission? Am I a repairman? A coach? Or a doctor?"

© Copyright 1998 The Washington Post Company

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