The Science & Marketing of Sex Drugs
By Ayesha K.

In 1998, good fortune smiled upon Pfizer when it began the sale of Viagra, the mother of all drugs to treat erectile dysfunction. Erectile dysfunction, also known as impotence, is defined as the inability to achieve and successfully maintain an erection of the penis. The scientists working diligently at Pfizer were actually develop a drug to treat angina, a common heart condition which results when the coronary arteries cannot supply sufficient blood to the heart muscle. An angina can result in severe chest pains and is often a precursor of a full-blown heart attack.

The Long Road to Pleasure

The long road to Viagra started thirteen years earlier in 1985, when scientists at Pfizer began to think of ways to treat angina by creating a drug that would cause the muscles in the coronary artery to dilate and relax, thereby letting in greater flow of blood. The concept was simple: find a compound that will inhibit the constriction of blood vessels. But the implementation was long and painful, as is often the case with research and development of drugs.

Between 1986 and 1990, Pfizer scientists tested hundreds upon hundreds of possible molecules that would achieve this effect. Finally, one molecule was deemed to be promising and it was decided to test this molecule in clinical trials. The medicine built of these molecules was called Viagra, and in 1991, healthy volunteers began to participate in trials to test the safety of the drug. The volunteers affirmed that the drug had been metabolized safely by their bodies, but also pointed out another unusual side effect: they seemed to be getting more frequent erections after taking the medicine. Surprised, Pfizer began investigating the use of Viagra in erectile dysfunction treatment along with its role in treating angina. As it happened, Viagra was not powerful enough to combat angina but it was heaven sent in treating erectile dysfunction.

In 1993, Pfizer began clinical trials specifically to test the efficacy and safety of Viagra for erectile dysfunction. Unequivocally, Viagra proved a great success and Pfizer got a license to market the drug in six months after it applied for the license. In 1998, Viagra went on the market and within 3 months, there were 2.9 million prescriptions for the medicine. Since then, Viagra has generated over $1.5 billion for Pfizer every year.

The Science Behind Viagra

Surveys show that around one-third of all men suffer from erectile dysfunction; in the US, for instance, there are an estimated 39 million men suffering from the problem. The cause can be physiological or psychological; either way, it is the cause of tension in families and relationships, not to mention embarrassment on the part of the men suffering from it. Women feel unattractive, believing that their partners are no longer attracted to them, and a number of misunderstandings arise between couples. For years, it seemed that there was no real cure to the problem, and often men and couples resigned themselves to the possibility of never having a normal sex life. The creation of Viagra was, therefore, a huge breakthrough in erectile dysfunction research. In order to understand the nature of the problem and how it was tackled, the penis and how it works has to be understood.

When a man is sexually aroused, his brain sends signals to the arteries that feed the spongy tissue surrounding the penis. The signals stimulate the arteries to dilate, thereby increasing the blood flow into the tissue. The rush of blood from other parts of the body to the penis causes it to become hard and erect. To be exact, the signal, sent via nitric oxide, results in the release of a molecule that causes the blood vessels to dilate. This molecule, cyclic guanosine monophosphate (cGMP), is stimulated by the enzyme adenyl cyclase. True to the yin yang of nature, as things are built up, other enzymes curb this build-up to maintain balance in the body. Phosphodiesterase (PDE) is the enzyme that reins in the cGMP by breaking it down; this results in the vessels contracting back to normal after a while. Any medicine which successfully stops PDE from breaking down cGMP will curb the decrease in dilation. In fact, this is exactly what Viagra does: it specifically targets PDE and inhibits its effect, thereby allowing dilation to continue and the erection to last longer.

This dilation of arteries, known as vasodilation, works exactly the same way in every part of the body. However, there are several different types of PDEs that are found in different parts of the body. The type 3 PDE is found in the cardiac area whereas the type 5 PDE is found in the penile region. Viagra is 1000 times as effective an inhibitor of the type 5 enzyme as for the type 3 enzyme, which explains why it was eventually discarded in combatting angina.

Marketing Sex Drugs

As Pfizer began to enjoy its complete dominance of the erectile dysfunction market, other pharmaceutical companies scrambled to create their own versions of the drug. Two new drugs, in particular, came on the market: Levitra and Cialis. GlaxoSmithKline and Bayer's Levitra was launched in summer 2003 and accompanied by a very aggressive marketing campaign. Interestingly, while it was no secret that the impotence drug worked, the biggest challenge for the pharmaceutical companies lied in trying to lure the men suffering from the dysfunction to ask for a prescription from their doctors. It seemed men just didn't want to speak about erectile dysfunction or impotence and were too ashamed to approach a doctor.

The makers of both Viagra and Levitra began to get celebrity spokesmen who touted the benefits of coming out and speaking about "it". Initially focusing on the older generations, Pfizer held a widely publicized campaign with Republican Senator Bob Dole. Since then, it has been targeting the middle-aged demographic and taken on Texas Rangers slugger Rafael Palmeiro as a spokesperson. Research has shown that sports is increasingly the most effective way to reach the target market, since millions of men watch sports and idealize sportsmen for their physical strength and virility.

The latest member to join the club, Cialis, took another approach altogether. Known as the "le weekender" because it enables erections to last over 36 hours (note that all of these drugs depend on arousal to sustain erection; simply taking the drug will not result in an erection). Lilly ICOS launched Cialis with a $100 million campaign that had no celebrity spokesmen, just the tagline "When a tender moment turns into the right moment, you'll be ready." Since it was approved by the FDA in November 2003, Cialis has become increasingly popular with consumers and is considered a real threat to Viagra.

Usually, the market and media is blamed for hyping certain products beyond their advantages when such enormous amounts of money is spent on marketing. However, if taken properly, Viagra & co. have proved a formidable force in combating erectile dysfunction, a problem that has plagued men for centuries.