[SUBSTANTIAL ERROR IN TEXT BELOW: SEE UPDATE]
Viagra is a drug approved for the treatment of erectile dysfunction (“ED”): what used to be called “impotence” before the marketing guys got their hands on it. For those men who actually suffer from that disorder, Viagra has no doubt been a blessing, though as far as I know no one has asked their wives what they think.
As everyone knows, though, most of the river of Viagra currently flooding this country and the rest of the world, and in the process earning something over a billion dollars a year for Pfizer, isn’t used to treat anything more serious than the desire of 60-year-olds to perform sexually as if they were 20, or even the desire of 20-year-old to achieve feats of sexual athleticism they can look back on fondly when they’re 60.
That seems fine to me. It’s even legal. Although the drug was approved for the treatment of ED, any physician can prescribe it to any patient for any medical purpose, and it would be hard to argue that improved sexual vitality isn’t an aspect of improved health.
Arguably, it ought to be possible to get a drug approved specifically for the purpose of making normal function better, rather than curing some disorder. (There’s some tricky territory around that “better than well” idea, though: some thoughts on that here.)
Although “off-label” use of Viagra by those not coitally challenged is entirely legal, lots of the commercial activity around the drug isn’t. The Internet “pharmacies” that have physicians on staff who will “prescribe” the drug for people they’ve never even talked to, let alone examined, are clearly breaking the law. Pfizer’s willingness to continue supplying the drug to the distributors who in turn supply the scofflaw on-line drug dealers ought to raise eyebrows, but it doesn’t. (You can bet that, if those websites were selling counterfeit Viagra, Pfizer would have its lawyers and private investigators all over them like a cheap suit.)
As a participant in the licit pharmaceutical industry, Pfizer might be thought to have a responsibility — moral if not legal — to help keep the activity surrounding its products strictly legal. At minimum, you’d hope that the executives of a big, respectable pharmaceutical firm — one of the outfits that keep telling us how much they care about our health and how we shouldn’t under any circumstances deprive them of the money they need to keep making us healthier — would have a different attitude than, say, the executives of Phillip Morris or MacDonald’s, about the risk of health damage resulting from the use of its products.
Well, keep hoping. It turns out that Viagra, especially in combination with methamphetamine, is associated with the spread of syphilis and HIV among gay men. At least, that’s the view of Jeffrey Klausner, San Francisco’s chief public health doctor working on STD, and he seems to have lots of evidence. He’d like Pfizer to do something about it, such as changing its advertising (which currently merely tells consumers that Viagra doesn’t prevent sexually transmitted disease). Pfizer is stonewalling, refusing to admit that there’s even a problem to worry about. “Any pharmaceutical product can be abused, and that’s beyond our control,” a Pfizer spokesman told the LA Times.
Pfizer’s attitude reminds me of the way Purdue Pharmaceuticals watched cheerfully as its blockbuster drug Oxycontin created an epidemic of narcotic addiction in places that had never had one before. As long as the cash registers keep ringing, Pfizer, like Purdue, doesn’t seem to care who gets hurt.
So here’s an idea to put the brakes on illegal Viagra marketing:
Make it a controlled substance. Start with Schedule III, where the anabolic steroids now are; if that doesn’t get things under control, move it up to Schedule II, along with oxycodone and the amphetamines.
Viagra fits the legal criterion for scheduling, which is simply “abuse liability,” where “abuse” is defined as use outside a medical context. A drug doesn’t have to be psychoactive to be controlled; that’s how the anabolic steroids got themselves on the list.
Making Viagra a controlled substance would create some inconvenience for men with actual ED, and somewhat more inconvenience for men who just want to improve their performance in bed, but it would still be entirely legal for any physician to prescribe it to any actual patient. Scheduling Viagra obviously wouldn’t entirely stop its illegal distribution; diversion is always a problem. But it would make recreational Viagra more expensive and harder to get. That would save some lives.
It would be preferable to have Pfizer do the right things — putting warnings in its advertising, getting the word out to physicians not to hand the stuff out as if it were aspirin, monitoring its distribution channels — voluntarily. The company could produce most of the benefits of making Viagra a controlled substance at a fraction of the costs. Maybe the mere theat of scheduling Viagra would be enough to do persuade the folks who run Pfizer to act as if they were in the health-care industry rather than the snake-oil racket. If not, let’s just go ahead and schedule the stuff.
Of course, the official who made Viagra a controlled substance would bring down on himself a torrent of ridicule and abuse. As it happens, though, the official with the authority to act is the Attorney General, who doesn’t seem averse to making enemies.
An anonymous reader who is also an internet buyer of the drug reports that most of the internet traffic is now in generic sildenafil manufactured in India.
He and another reader wonder why Viagra shouldn’t be an over-the-counter drug. They must have a better opinion than I do of the judgement of fourteen-year-old boys.