HOW IT WAS discovered . . . by accident
Scientists at the pharmaceutical company Pfizer discovered the powers of Viagra (sildenafil citrate) by accident in the early Nineties during trials of a potential new angina drug named UK-92480.
Angina is a condition in which the vessels that supply the heart with blood constrict, triggering chest pain and breathlessness.
UK-92480 was found to do little to relieve pain, and Pfizer was on the verge of abandoning the drug when reports began to show a distinctive pattern; many male trial volunteers were experiencing an unusual side-effect . . . erections.
Scientists at the pharmaceutical company Pfizer discovered the powers of Viagra (sildenafil citrate) by accident in the early Nineties during trials of a potential new angina drug named UK-92480
Rather than dilating their coronary blood vessels as hoped, the blood vessels of their penises became dilated instead.
Senior Pfizer scientist Chris Wayman investigated what was happening by testing the drug on penile tissue samples from impotent men. The effect was dramatic.
U.S. regulator, the Food and Drug Administration, approved Viagra in 1998. Before this there was no oral treatment for erectile dysfunction; the only options were an injection or a prosthetic implant.
Viagra is thought to be effective for up to six hours, and while it does not stimulate desire, it does help a man to establish and maintain an erection if he feels aroused.
Viagra’s subsequent success is the stuff of pharmaceutical legend. Pfizer continues to make Viagra at its plant in a small village called Ringaskiddy in County Cork — dubbed ‘Viagra Falls’ by locals, who also claim to enjoy amazing sex lives because of the Viagra ‘in the air’.
30 million men who got it on prescription
In its first ten years alone, nearly 30 million men worldwide were prescribed Viagra with sales of more than £1 billion. In Britain, prescriptions for Viagra (and other erectile dysfunction drugs) have nearly tripled in the past decade.
NHS figures show there were some three million prescriptions in 2016 (at a cost of £47 million), compared with just over a million in 2006. Between 2014-2015, prescription numbers rose by 43 per cent and by 16 per cent between 2015 and 2016.
The Royal College of General Practitioners (RCGP) attributes the sharp rise to growing awareness of erectile dysfunction and its treatment, and an ageing population who expect a good sex life.
According to NHS data, men in Bradford are the most likely in the England to be prescribed Viagra (or similar drugs), at twice the national rate, with Blackpool second and South Lincolnshire third.
There seems to be a North-South divide, with the lowest prescription rates in East Surrey, Richmond and Kingston upon Thames.
Brick dust in counterfeits
Doctors are concerned that men are buying Viagra-type drugs online, putting themselves in peril from counterfeit chemicals.
Prof Helen Stokes-Lampard, the chair of the Royal College of General Practitioners says buying Viagra and similar drugs online exposes men to a ‘powerful drug that could have potentially unpleasant side-effects, and serious interactions with other medication’.
Some £50 million of unlicensed and counterfeit erectile dysfunction drugs have been seized since 2012.
Analysis of these pills has found them to contain everything from gypsum (used to make plaster of Paris) to printer ink, brick dust and even arsenic. They are often manufactured by criminal gangs who see the potential of increased demand.
Officials from the Medicines and Healthcare Products Regulatory Authority (MHRA) say that in 2015, more than 90 per cent of all illegal unlicensed medication seized was for erectile problems, much of it sold via foreign-based internet sites.
Doctors say there is a growing trend for younger men using Viagra and similar drugs
Taken to counter effects of drink
Doctors say there is a growing trend for younger men using Viagra and similar drugs.
They may want to improve sexual performance or take it to counter the use of other recreational drugs and alcohol which make it harder to get an erection.
Seth Rankin, an NHS GP and chief executive of the London Doctors Clinic, a private chain of GP surgeries, says many twentysomethings take Viagra-type drugs because they watch a lot of pornography and feel pressure to perform.
In 2012, writer James Andrews, 24, from North London, killed himself after apparently lying to his girlfriend, a dancer with the English National Ballet, about his use of Viagra (athough it was not explained why the drug was an issue for the couple).
Users who doubt their virility
Long-term studies suggest that Viagra and similar drugs don’t have any serious side-effects. A Swedish study published earlier this year found that people who have had heart attacks seem to enjoy a lower long-term risk of heart attacks if they use erectile dysfunction drugs regularly.
However, young men who use Viagra as a lifestyle drug can harm their potency, because they begin to doubt their virility without it, and develop a psychological dependency on it.
According to the Journal of Sexual Medicine, a 2012 study found that nearly six per cent of sexually active college students reported taking drugs for erectile dysfunction without a medical need.
Further analysis of their sex lives found that, paradoxically, the more Viagra-type drugs men took, the lower their sexual confidence.
Price slashed from £20 to £1.45
In 2013, Pfizer’s exclusive 15-year patent on Viagra ran out, enabling cheaper, generic ‘sildenafil’ drugs to come on to the market.
This prompted an 86 per cent drop in the price of the pills — and enabled NHS doctors to prescribe far more within their budgets.
For example, the number of men in North Wales receiving the pills has risen by 60 per cent since 2013, which NHS officials attribute to the plummeting cost. The price, once around £20 for four pills, is now as low as £1.45.
This month, the price of another drug to treat erectile dysfunction, Cialis — which lasts up to six times longer than Viagra — was slashed by up to 50 per cent (from £7.22 per tablet to £2-4) after the brand’s patent expired.
It may now become available on NHS prescription.
Search for a female version
Over the years, there have been many attempts to create a ‘pink Viagra’ to boost women’s sex drives — not least because of the promise of sure-fire profits for pharmaceutical companies.
However, all attempts have failed. Scientists believe that the main reason for this is that a woman’s main sex organ is ‘between her ears rather than between the thighs’, as is the case for men.
One drug company tried to solve this by marketing a drug called Addyi to treat low female libido.
It boosts bloodflow to the pelvic region and also acts on the brain, raising levels of ‘feelgood’ chemicals such as serotonin and dopamine.
The theory is that women’s brains will experience more pleasure during sex, and that the raised levels of ‘feelgood’ chemicals reinforce pleasurable memories of the encounter.
However, Addyi can also cause sleepiness, sudden drops in blood pressure and fainting, especially when it is combined with alcohol. Since it became available in 2015 in the U.S., sales have been woeful.
I worry the blue pills are being misused
By Dr Max Pemberton
Viagra, the little blue pill that can conquer impotence (or erectile dysfunction as we doctors call it), has been the subject of bawdy jokes ever since it first became available nearly 20 years ago.
However, news this week that Britain is to become the first country in the world where Viagra can be purchased from pharmacies, without a prescription, is nothing to laugh about.
The decision by the Medicines and Healthcare Products Regulatory Agency is designed to combat the illicit internet trade in the drug and has been applauded by the police and public health bodies.
Every day countless thousands of men worldwide order ‘Viagra’ from unlicensed websites, unaware that it may be illegal to do so, possibly counterfeit and ineffective at best, or possibly toxic at worst.
Last year, stocks of fake Viagra worth an estimated £17 million were seized in Britain.
Every day countless thousands of men worldwide order ‘Viagra’ from unlicensed websites, unaware that it may be illegal to do so
As for GPs, I’m sure, too, that there will be a fair number of them relieved that they will no longer have to contend with ‘patients’ who have nothing wrong with them medically, but who are simply trying to secure a prescription for Viagra to boost a flagging sex life or for their ‘recreational’ use.
This is not only a waste of NHS time, it also denies valuable appointment slots to those who really need them.
For myself, I have deep concerns about easier access to Viagra. There are many reasons why men suffer erectile dysfunction, including heart and circulatory problems, especially in older men, and diabetes.
Impotence is also an unwanted side-effect of certain drugs, such as anti-depressants, while psychological problems such as stress and ‘performance anxiety’ can affect arousal in otherwise healthy men.
All of the above necessitate a discussion with a GP who is, ideally, familiar with the individual and who can establish the cause.
In some cases, perhaps where heart disease or diabetes is undiagnosed, or getting worse, it could quite literally be a life-saver.
Viagra — its chemical name is sildenafil citrate — also has significant side-effects including heartburn, headaches, flushed skin and, in rare cases, hearing loss.
Buy a pack of tablets over the counter and you might not be aware of this unless you study the small print.
A GP can insist on explaining these to a patient.
But with all due respect, I’m not sure that a pharmacist or pharmacy assistant carries the same authority, or will be as alert to the lies men might tell about their health in order to get the drug.
And most users or potential users are completely unaware of how dangerous Viagra can be when taken in combination with common heart medications (as well as recreational drugs such as ‘poppers’ which, like it or not, are widely used by thousands of people during a night out).
Of course, for the manufacturer Pfizer, it’s all about profit. The drugs giant aims to have Viagra Connect, in packs of four and eight tablets, retailing at £19.99 and £34.99, available in pharmacies by early next year.
By the time their 15-year patent on Viagra lapsed in 2013, Pfizer had made almost £1.5 billion from the drug worldwide. Now it has to compete with cheaper, generic brands of erectile dysfunction drugs, as well as counterfeit trade.
The over-the-counter opportunity opens up a lucrative and legal new market. It is a market that will be fuelled by — and this is at the heart of my concern — the growing perception among all age groups, of Viagra as a ‘lifestyle’ rather than therapeutic drug that will guarantee better sex. Hence the booming illegal trade online.
Myths about its use, such as the idea that it never fails, or that it can permanently increase the size of the male member, are widely taken as gospel.
I also think the ease of access to hardcore porn, which is viewed more and more by young men, is undoubtedly a factor in the demand for Viagra and similar drugs.
What once could be viewed only in a ‘top-shelf’ magazine or on screen at a Soho cinema, is now instantly available online.
Men see well-endowed male porn stars engaged in prolonged sexual activity with cosmetically enhanced females, and expect their sex lives to mirror what they see on their laptop.
And if a little blue pill can help, then so be it.
I also worry about ‘chem sex’ — an Orwellian term for chemically enhanced intercourse.
Casual drug use at weekends is common among the under-30s, both heterosexuals and even more so in gay circles.
Lots of the so-called ‘party drugs’ such as cocaine and crystal meth, don’t just loosen inhibitions, they can also make it difficult to get and sustain an erection, so men rely on Viagra.
The rise of chem sex — again, inexorably linked to the ready availability of Viagra and similar drugs online — has been linked to an increase in sexually transmitted infections, including HIV and it is becoming a major public heath concern.
I accept that it’s almost impossible to devise and enforce a law that thwarts the online trade in Viagra (both illicit and fake).
But I am sceptical that making it as easy to buy as strong painkillers or a cough medicine is the answer.