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Viagra the King
 Hawkers in popular bars whisper that they have "blues" for 5 bucks a pop -- less than the pharmacy price. Friends pass pills along to others, often drug users who use them to counter the effects of drugs such as methamphetamines or Ecstasy, which can leave them unable to get an erection and web sites sell the drugs -- or counterfeits -- to nearly anyone.
Many healthy young men with normal sexual functioning are asking their general physicians for Viagra, Levitra or Cialis to help them conquer anxiety or offset the effects of smoking and partying. At the same time, the makers of erectile-dysfunction drugs are running racier campaigns targeting younger men and straying from the depictions of the drugs as medicine. "Get back to mischief," woos the latest Viagra slogan, with devil's horns seeming to emerge from behind a middle-age man's ears. These are all part of the rapidly changing face of erectile-dysfunction drugs. Since the first, Viagra, debuted in 1998 to address a physical problem some men face, it and newer drugs Levitra and Cialis -- the latter produced by Eli Lilly and Co. -- have been used increasingly by healthy younger men for perceived performance-enhancement purposes or as psychological life-preservers to alleviate performance anxiety. "When Viagra first came out, the whole emphasis was on older men, with Bob Dole doing the marketing and the age group being around 70," says Dr. Abraham Morgentaler, a urologist and associate professor at Harvard University. "Now we're seeing the bar lowered, not just for men wanting it but for physicians giving it out to those who are younger and less severely affected."
One concern is that the drugs may be psychologically addictive, says Morgentaler, author of "The Viagra Myth," a book on common misperceptions about the drug. Healthy men may begin to feel inadequate without it, he says. Many seem to have the wrong idea about the drugs. The pills enable some men who have hypertension, diabetes or prostate problems to get an erection by increasing blood flow to the penis, provided the brain kicks in with some sexual stimulation. They don't make people better lovers, instantly mend broken relationships or enlarge body parts. Still, drug companies and many doctors say they don't believe the drugs are being overused and, in any case, see little danger in them. About 75 percent of the erectile drugs are now prescribed by general practitioners rather than urologists or cardiologists. Pfizer, which sold $1.9 billion worth of Viagra last year and says 23 million men worldwide have tried it, maintains that it is not promoting the drug for enhancement purposes. Pfizer spokesman Daniel Watts says the company believes that if a man is troubled enough by problems, then he should consult a doctor about a possible underlying condition. Carole Copeland, a Lilly spokeswoman, says the company "strongly discourages" use by those seeking enhancement only. "It's just not safe. People who don't have a condition that necessitates it shouldn't use any drugs," noting that erectile dysfunction drugs can be deadly if taken with nitrates. The U.S. Food and Drug Administration and physicians say the drugs are safe for most men if used as directed, except for those taking nitrates or those in poor cardiovascular health. They acknowledge that some men experience headaches or flushing and in rare cases extended and painful erections.
Cedars-Sinai cardiologist Kaul isn't convinced that the drugs are safe and says he probably wouldn't take them himself if he were to need them. In 2000, he and colleagues at Cedars-Sinai analyzed 1,473 major adverse reports associated with Viagra use filed with the FDA. Of those, 522 people died, most due to heart attacks. Most had taken the standard 50 milligram dose within the previous few hours, and most were younger than 65 and had no known cardiac risk factors. Some of the deaths occurred in patients who had taken the drug with nitrates, but 88 percent of the deaths had occurred in those who had not. Kaul notes that one cannot be sure that the medication caused the attacks, just that there was an association with taking the drug. It also could be that some of the victims had previously been sedentary and the drug enabled them to engage in sexual activity, which in itself caused the heart attack.
Sam Fields
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