A new treatment for male impotence is taking the world by storm, writes Tim Radford
Lewis Carroll should have patented the idea: swallow a little something and feel just swell. “I know something interesting is sure to happen,” said Alice when she found the bottle. “I hope it will make me grow large again, for I really am quite tired of being such a little thing.”
Viagra, the new impotence treatment from Pfizer, has just become the world’s fastest selling prescription drug, although it was cleared by the United States Food and Drug Administration only this month. Most drugs sell a few thousand packets in their first week. Viagra topped 150 000. Doctors complained of writer’s cramp.
One far-sighted consultant at a urology clinic actually prepared a rubber stamp to speed the fulfilment of demands from anxious Americans. The estimate is that one male in 10 suffers from some degree of impotence: nobody knows for certain. But in the US alone (the only country where Viagra is currently licensed) the market could run to 20-million.
These men already spend $70-million annually on uncomfortable or even terrifying impotence treatments. The arrival of a pill that actually works, and works when you most want it to is a huge event.
Financial analysts put the sales at $600-million a year by 2000, and four or five times that by 2004. Time magazine was aroused enough this week to devote eight pages to Viagra madness.
“Viagra”, a conjunction of “Niagara” and “vigour”, is the drug’s brand name that replaced its clumsier chemical label “sildenafil”.
Like Henry V, it rushes into the breach. It stiffens the sinews and summons up the blood. It’s the upwardly mobile treatment every dispirited male has dreamed of.
It is also a startling instance of a new way of thinking about the human condition: as a perambulating sack of cellular machinery. What matters is not so much the whole person as the whole bag of 100-trillion cells shaped into biped form.
Why does bad food make you ill? A bacterium assaults the cells. Why does rabies drive you mad? A little virus colonises your nervous system, invades your command centre and takes control in the brain. Why does cancer happen? Because cells go haywire when assaulted by carcinogens.
So clearly even love itself is chemistry: some process that might one day be modelled in a laboratory. Scientists confirmed a few years ago that nitric oxide (chemical formula NO) was indeed a wonder molecule that trafficked about the mammalian physiology, making important things happen, in memory, in blood pressure and so on.
It acted as a go-between: it read a signal from a chemical messenger in the brain and carried it to the tissues that pump blood and stiffen muscles. It had a powerful role in assembling erections. It was a turning point.
The aphrodisiac business is an old one. Usually the evidence has been suggestive rather than investigative: the Asian faith in powdered rhinoceros horn, for instance, is based on the sturdy, upright symbolism of the organ. It brought the rhino to the point of extinction, and probably did nothing for manhood in China.
On the other hand, according to biochemists, aphrodisiacs that schoolboys used to whisper about – Spanish fly, for instance – do have biologically active ingredients. Mylabris from the beetle mylabris phalerata could irritate the urethra to the point of priapism (basically, an erection that will not go away). Enough of it would also kill the person who took it.
Sybarites spoke well of things like ginseng, oysters, and wine, but there was never any evidence that good living meant good loving. Even when the old love elixirs worked, no one knew why or how.
The new class of treatments for many of the human conditions – Viagra is only one of hundreds in the labs – are different. They are chemical spanners tailored to undo or tauten precisely this or that nut in the cellular machinery, and then disappear, leaving few or no side effects.
There are likely to be drugs for waistlines, and for hair loss. There will be attempts to halt the ageing process with pills. There are likely to be new, precise, effective treatments for depression, for hyperactivity, for memory failure.
There could be more than 100 new “smart drugs” to enhance cognitive powers or slow memory loss in Alzheimers patients: but once they’re out there, others will want them too. If there’s a “smart pill” that confers an advantage in the competitive jungle, who wouldn’t want to take it? And if there is a happiness pill that doesn’t let you down – Prozac is already in huge demand – who would be miserable?
Steven Rose is a biochemist and neuroscientist at the Open University who has been examining, with a wary eye, the political impact of modern science on how humans think and feel. He, like everybody else, is in two minds about the Alice-in-Wonderland solution, the chemical message in a bottle with an answer to your cares, the eat-me cake that can make you what you always wanted to be: slim, debonair, confident and potent.
It’s like something out of Aldous Huxley’s Brave New World, he says. “Hug me till you drug me, honey. Love’s as good as soma.” Soma was the Brave New World solution to melancholy or alarm. But Huxley was fiction. This is real. This is the answer, pharmacologically designed just for you.
A pill that limits the desperate draining away of memory and identity in senile dementia is one thing. That a cognitive- enhancer or smartness pill might also help an airline pilot scrape through examinations that he or she might otherwise fail should scare the hell out of everyone. For most of us, forgetfulness is a property we ought to bear in mind.
“The brain is rather exquisitely tailored to meet most of the world around us most of the time. Remembering everything isn’t so smart anyhow,” he says. “Forgetting is quite functional. So why do we want these drugs for normal people in everyday life?”
Rose does not disapprove of Viagra. “Most men have huge sexual anxieties a good chunk of the time. Their cocks are not as big or as effective as they might be, and as we grow older we tend to drop off in that way.” What concerns him is a belief that somehow humans have a right to be perfect and successful at everything.
It might worry Rose. It never worried the snake oil salesmen. These practitioners, knowing or deluded, have been selling simple solutions to the anxious since the dawn of civilisation. Generations tended to adopt new nostrums as they emerged: faith kept them going for a while thereafter.
Eno’s Fruit Salts or Beecham’s Powders may have “worked” merely because people wanted them to work. A cancer “cure” such like the notorious Laetrile, derived from apricot pits, might not have offered life, but it offered hope when nothing else did.
Besides, new vigour would often appear in old remedies. The Aids treatment, AZT, for instance was briefly considered as a cancer drug and then abandoned: until the right disease turned up.
Aspirin, a white powder and painkiller produced by Bayer in Germany 100 years ago (along with that other white powder heroin), is turning out to be more and more useful for more and more afflictions.
On the other hand, Melatonin, hailed as a wonder treatment for cancer, Aids, coronary heart disease, longevity and sexual vitality, has turned out to be quite good for some sleep disorders. Faith heals, but not indefinitely.
Viagra may turn out to have a downside. And the promised tailor- made lifestyle pills may also disappoint.
Fifty years ago, neuroscientists thought they had discovered the ideal happiness treatment. It began experimentally in Europe and was developed in the US. “Operation to cure sick minds turns surgeon’s blade into instrument of mental therapy,” said Life Magazine in 1947.
Actually, the treatment was lobotomy: it ruined thousands of lives. “Desperate patients justify taking some therapeutic risks,” said Elliot Valenstein of the University of Michigan, “and these are not uncommonly followed by premature reports of cures, some of which are accepted uncritically. The media still promotes questionable treatments, often with the encouragement of physicians. Economic factors, in their many guises, still influence the attractiveness of certain treatments …”
Sound familiar? And will Viagra turn out to be such a marvel a decade onwards?