Viagra

In their 2000 study, Harrold et al. examined the use of Viagra in the first six months of its availability in a managed care setting in order to determine prescribing trends, characteristics of Viagra users, prescriber characteristics, and usage patterns in a cohort of Viagra users. They found that media attention clearly resulted in a greater awareness of erectile dysfunction as a treatable condition, and increased the demand for the drug. In fact, almost 60% of American patients who were prescribed Viagra had never sought medical attention for the problem, and as such had no documentation of prior treatment for erectile dysfunction. The study also found that 85% of firsttime prescriptions being filled for the drug occurred within the first twelve weeks of its availability (Harrold et al., 2000). Physicians have always been the direct link between pharmaceutical producers and patients, which is why the pharmaceutical industry spends billions of dollars on symposia and galas for physicians, offering incentives for prescriptions, and advertising and promoting their products to physicians. The role of physicians as “providers” however, is changing in the current medical marketplace, particularly due to direct-toconsumer advertising undermining their authority with regards to which drugs to prescribe (Conrad and Leiter, 2004). The Federal (USA) Drug Administration Modernization Act of 1997 made drug advertising both more feasible and more attractive to pharmaceutical manufacturers, a development which Pfizer used to their advantage when marketing Viagra in 1998 and onwards. The changes to the act, which now allowed television and radio advertisements to name both the disorder and the drug’s benefits without a lengthy summary of potential side effects and contraindications, are seen as the main reason for annual spending on direct-to-consumer advertising for prescription drugs tripling between 1996 and 2000 (Conrad and Leiter, 2004). Pharmaceutical companies claim that direct-to-consumer advertising has an educational function that creates betterinformed consumers, encouraging them to consult their physicians about underdiagnosed symptoms and treatment options, and enabling patients to make better choices with regards to their health care (Bonaccorso and Sturchio, 2002; Lyles, 2002). The American College of Physicians has stated its position that consumer advertising “does not constitute appropriate patient education” (Maguire, 1999). Regardless, 3.5% of Canadian patients, and 8.2% in the United States, report using advertising as an information source (Mintzes et al., 2003). Although these figures appear negligible, it must be considered that although some patients may not consciously employ such sources to provide information, they nonetheless internalize the messages they are exposed to daily by various media. A study by Mintzes et al. compared prescribing decisions in a US setting with legal direct-to-consumer advertising and a Canadian setting where such advertising of prescription drugs is illegal, but some cross-border exposure occurs (2003). The results suggest that more advertising leads to more requests for advertised medicines, and more prescriptions. If direct-to-consumer advertising opens a conversation between patients and physicians, that conversation is highly likely to end with a prescription, often despite physician ambivalence about treatment choice. Pfizer’s advertising of “ask your doctor” takes advantage of such dynamics between patients and physicians. Given that a potential patient inquires about Viagra to their physician, a prescription, and concurrent sale of the drug is more likely than not. According to Mintzes and colleagues, physicians fulfilled, on average, 75% of requests for direct-toconsumer advertised drugs (2003). Conrad and Leiter hypothesized that pharmaceutical manufacturers are circumventing physicians’ control over knowledge regarding available drugs (2004). The case of Viagra certainly supports this notion. Physicians are increasingly frustrated that the developments associated with increased direct-to-patient advertising are putting their patients in the “diagnostic driver’s seat” (Maguire, 1999). Some note that increasingly, patients are presenting them with lists of drugs which they would like to try, many of which are neither “time-tested” nor “cost effective” (Maguire, 1999). Other physicians state that patients believe that certain (advertised) drugs are going to be a panacea for their problems, and as a result pressure them for prescriptions, regardless if the physician feels otherwise.