Viagra living up to billing

Art Nadler

Monday, Aug. 10, 1998 | 10:42 a.m.

It's been four months since the little blue pill Viagra exploded onto the market, and -- even though sales have slowed somewhat this month -- it continues to be a popular treatment, area physicians say.

Las Vegas urologist Dr. Sheldon Freedman says he is seeing three times as many men seeking treatment for impotence since the introduction of Viagra on April 10. He says this is good because it has allowed urologists to detect early stages of prostate cancer and other health problems that otherwise would have gone undiagnosed.

"Most men are mechanically minded," Freedman said. "You explain to them that something is broken and how it can be fixed, and they'll do it."

Viagra, whose generic name is sildenafil citrate, enhances the effect of the natural chemical that is created during sexual stimulation. Sexual stimulation begins, on average, about a half-hour after taking Viagra.

One 62-year-old Las Vegas resident, who requested anonymity, said he started taking Viagra three months ago. Prior to that, he was getting a couple testosterone shots a month.

The testosterone gave him the sexual drive, but his erections weren't living up to his desire.

"The first time I used (Viagra), it worked," he said. "It gave me a bigger, stronger erection. I take half a pill, twice a week. I don't use it all the time, but it takes a load off my mind (psychologically)."

The man, who has been married 18 years, says Viagra has strengthened his marriage. He and his wife have sex about four times a week, he said, and their physical closeness has improved tremendously.

Prior to Viagra, male impotence was treated by injecting a drug into the penis or inserting a suppository up the urinary tract to induce sexual drive. Penile implants are a third solution.

Dr. Rodney Handsfield, a Las Vegas urologic surgeon, said an implant is the most effective method, but the procedure costs about $20,000 if done in the hospital. Injections cost $25 a shot.

"Viagra is one of the rare drugs that seems to be as good in practice as in advertisements," Handsfield said. "I've put about 90 percent of my patients on it. I'm seeing about 75 patients a week and putting them on Viagra."

At $10 a pill, it's not surprising that taking Viagra would be more appealing than undergoing the invasive surgery of an implant or injecting drugs.

It's estimated that 30 million men nationwide, including half of all males with diabetes, suffer from sexual dysfunction. According to Pfizer Inc., the manufacturer of Viagra, the drug has helped men with multiple sclerosis, heart disease and hypertension, spinal-cord injuries, diabetes, aging and several other medical conditions.

The side effects -- which not every male user experiences -- may include headaches, indigestion and vision changes such as being sensitive to light or seeing blue tinges.

Most major insurers have been reluctant to pay for Viagra. Blue Cross and Blue Shield is restricting coverage to men who have been diagnosed with organic impotence. Kaiser Permanente, the largest health-care organization in the nation, has refused to cover Viagra prescriptions.

Dr. Francis Crosson, executive director of The Permanente Federation, said the cost now is too expensive. Providing 10 Viagra pills a month for its members, he said, would cost a minimum of $100 million.

In comparison, Crosson said Kaiser spent $59 million in 1997 for all anti-viral drugs that included protease inhibitors for treating HIV patients.

Ria Marie Carlson, vice president of public relations for Sierra Health Services Inc., the largest health maintenance organization in Nevada, said his company will study the health affects of Viagra on patients for the next year.

"We don't cover any drugs for erectile dysfunction," Carlson said. "If we were to cover it in the future, it would be for a medical necessity."

Ross McLerran, a spokesman for Humana Health Plan, said his HMO doesn't cover Viagra. Both Humana and Sierra Health Services have said they are worried about the possible long-term effects of the drug.

"We usually don't cover a new drug until we have a chance to look at the scientific data," said Susan Whyte-Simon, a spokeswoman for PacifiCare, which also doesn't cover Viagra. "The American Urological Association and National Institutes of Health haven't come out with studies."

Whyte-Simon said PacifiCare was being cautious because even though the Food and Drug Administration has approved Viagra, it recalled five drugs last year -- including a portion of the popular diet treatment known as Fen-phen.

Whyte-Simon said PacifiCare probably would make a decision within weeks on whether to cover Viagra.

Medicaid patients in Nevada will have access to Viagra because the Health Care Financing Administration said it must be made available like all other prescription drugs.

There are slightly fewer than 100,000 people on Medicaid in Nevada, Crawford said. Men make up about 10 percent of this population.

According to Pfizer, 21 specially constructed studies have been conducted on Viagra. These involved more than 3,000 patients between the ages of 19 and 87.

Viagra's success rate was first recognized at the 1996 American Urological Association's annual meeting, association spokesman William Glitz said, adding that it also was praised at this year's meeting.

Neither Pfizer nor IMS Health, a national pharmaceutical information organization that tracks data, had statistics on Viagra use in individual states. The Nevada Board of Pharmacy also didn't have records on use within the state.

Nationally, Pfizer reported that as of June 26, 2.7 million prescriptions had been written by 160,000 physicians. This represented $411 million in sales.

IMS Health has forecast that sales will reach $1 billion by March 1999.

Because sexual activity also increases cardiac activity, men with heart conditions should consult their physicians before taking Viagra. People who take nitroglycerine or other nitrate drugs could experience chest pains and a drop in blood pressure.

There have been 36 deaths possibly related to Viagra use out of 3 million men who have taken the drug.

Freedman said two other drugs, apomorphine and phentolamine, are scheduled to be available soon to treat male sexual dysfunction. They will work more centrally on the nervous system.

Pfizer claims men who have been on Viagra for several years continue to have normal erections.

But Handsfield has made an interesting observation among his patients. He's had to increase their dosage from 50 milligrams to 100 milligrams after three months.

"If people think that impotence will always be treated with a single pill," Handsfield said, "I bet a tremendous amount of men will see a change in three years." He said that as any aggravating condition -- such as diabetes, advancing age, etc. -- progresses, the Viagra will become less effective.

A more certain cure for impotence, Handsfield said, is a penile implant. He said it is usually 90 percent effective.

In comparison, Freedman said that Viagra works about 50 percent of the time.

Pfizer claims the success rate is much higher.