The Rise (and Rise) of Viagra

How the little blue pill has redefined masculinity -- and not for the better -- while Pfizer laughs all the way to the bank.

| Tue Sep. 28, 2004 3:00 AM EDT

"Get back to mischief" runs a caption topping the Viagra website, above the photo of a muscular forty-something guy who doesn't look like he needs much encouragement. Meet Viagra man. Crowned with devil-horns -- the tips of the Viagra logo's "V" -- he's the embodiment of the sexed-up vision peddled by Pfizer, the maker of the little blue pill that purports to offer millions of men relief from Erectile Dysfunction. "I'm a normal guy who once had a normal problem," he seems to say. "Now I'm a stallion."

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Happy ending, right? Not quite, says Meika Loe, whose book, The Rise of Viagra: How the Little Blue Pill Changed Sex in America, is out Friday, Oct. 1. Loe argues that Pfizer has turned male sexual insecurity to lucrative ends, essentially by creating, in Erectile Dysfunction, a new category of "problem" in need of (pricey) treatment. She says that widespread use of the drug by millions of men, young and old, is reshaping notions of masculinity to the point where male self-worth is in danger of becoming a function of supercharged sexual performance.

Loe examines the potent (as it were) confluence of cultural anxiety, profit motive, and mega-marketing that has put Viagra in the hands of 16 million men of varying ages since the drug's 1998 debut, making Pfizer one of the most profitable corporations in the U.S., and generating a web of social and psychological ramifications that are only just beginning to be looked at.

Meika Loe spoke to Mother Jones from her office at Colgate University, where she is Assistant Professor of Sociology and Women's Studies.

MotherJones.com: You argue that Pfizer -- and the pharmaceutical industry generally -- has essentially "created" the problem of sexual dysfunction in order to sell a solution. How did this happen?

Meika Loe: It’s a story about the happy test subjects who were signed up for a critical trial for angina and had a particular side effect -- blood circulation to the genitals. Pfizer suddenly had a product on their hands they weren’t sure what to do with. They created a sanitized medical campaign filled with science and statistics, and they changed the language of "sexual dissatisfaction" to [that of] "sexual dysfunction." In constructing a problem, they had to arm themselves with statistics. The role of the doctor-salesman was very important in this. The doctors who work as consultants to the pharmaceutical industry, who are paid spokespeople for the pharmaceutical industry -- those were the doctors that were interviewed when we read all of those thousands of debut stories about Viagra coming to the public.

MJ.com: You write that Pfizer has "succeeded in keeping male sexual problems and potency in the spotlight." How have they accomplished this?

ML: Direct-to-consumer advertising -- which is a relatively new thing -- is one way. The most interesting thing I’ve found is watching the public face of Viagra change over six years. We’ve moved from Bob Dole, with an emphasis on erectile dysfunction and a real attention to medical conditions, to Rafael Palmiro, who is a pro-baseball player. There's more emphasis on younger men. So the demographic has changed; it's wider in terms of age and ethnicity. These marketing campaigns liken sexual performance to performance on the field; everything is reduced to performance. Then there are so many tie-ins with corporations, with professional athletics, so when you watch a pro baseball game, you see some sort of Viagra ad over home plate; that’s there for a reason. And then with NASCAR, you see the Viagra car. There is a constant PR campaign that keeps male sexual problems and potency in the spotlight.

MJ.com: You also argue that the pharmaceutical industry oversimplifies male sexual problems. How so?

ML: These marketing campaigns can have the effect of reinforcing very narrow ideas about what’s "normal" for men, reducing a man to erectile potential, which I think does a disservice to men. It’s no longer normal for men to have sexual problems. Men in their early twenties and my students here at the university who are plagued with performance anxiety, and want to be perfect in bed, and see themselves as well-performing sexual beings -- they're turning to pharmaceutical treatments to make that happen, rather than maybe talking with their partner or experimenting on their own without the help of medicine.

There are plenty of men who are so happy with the way they are when they are on the pill that they are psychologically dependent on this for feeling like a man -- not even being sexual, but feeling like a masculine individual. A performance culture is what we are bolstering here. It would be nice if there was room for human error and vulnerability and human reality in the broad spectrum of sexual pleasure and masculinity in all its form and more of a human based model here.

Also, there’s a statistic that was shared at an international sexual dysfunction conference last summer -- a statistic from Pfizer -- that half of the men who have prescriptions for Viagra do not refill their prescriptions. This may be because of side effects. It may also be because it’s not working for many men, particularly men who have severe erectile problems or impotence. And it may just be that Viagra is not really solving the problems in the relationship or in a man’s life, and that there are other avenues for dealing with those issues.

MJ.com: Is there a positive side to Viagra?

ML: Definitely. I think we’ve seen the positive side of Viagra for six years now, but I think it’s important not only to celebrate this important technology but also to be critical of its social ramifications. The Viagra phenomenon has implications for how we conceive of aging and how we think about masculinity.

MJ.com: What role has industry deregulation played in this?

ML: The pharma industry is the most profitable in the U.S. Academics and commentators have called this "the pharmaceutical era"; it’s an accepted part of our lives. The industry has unprecedented levels of control over every aspect of the medical process, whether it be education or sales or advertising, research or regulation. It can be problematic because we turn to pills more often than we turn to other explanations or treatments for our problems. With a pill we assume that the problem is solved, and many times there are other ways to look at it, other ways to treat so many of our problems.

We’re in an era where pharmaceutical companies wait for the day when they can find a blockbuster type of drug that can be a major revenue producer for them. And most of our blockbuster pills since Prozac have been developed for the healthy and the wealthy. We know that the pharmaceutical industry has an interest in treating those that are healthy because they have a longer lifespan to depend on a product. So we’re not necessarily putting as much energy into treating the diseases of the poor, which is quite troubling.

MJ.com: And what types of problems does this intersection of marketing and health research cause?

ML: I think we’re really seeing the fusion of science and capitalism, and that can be troubling when we still hold medicine and science up to a very high standard. Most people believe science to be quite neutral and unbiased. What they don’t know is that when they are looking at their favorite medical websites or seeing a news program that features a medical expert, a good number of those experts are paid consultants. I think we need to be wary of this … blurry line between science and marketing.

This is one of the things I did not anticipate going into my five years of research. I attended meeting after meeting about sexual dysfunction, medical meetings for medical credits, rooms of 500 medical practitioners and featured speakers. About halfway through my research I found out that the majority of the speakers are associated with the industry in some way, either as paid consultants or investigators, and that many of the people in the audience are, too. It even affects publishing of clinical trials. The sad thing is that most people don’t realize this.

MJ.com: If they did, do you think that would affect their use of Viagra?

ML: I would hope so. Many people go to their family doctor or their urologist and don’t realize that that uroligst is on the speakers’ bureau for Pfizer. And that might affect things, to know who your family doctor is working for. Certainly there are plenty of doctors who don’t accept pharmaceutical gifts and don’t want to be a part of the pharmaceutical world. But there’s a real lack of funding out there and so I think that many of these doctors and medical professionals have their hands tied, and the public should know that.

MJ.com: What are men saying about Viagra?

ML: Not all men are jumping up and down about Viagra. For the men that I spoke with -- and I spoke with quite a few of all different ages and ethnicities and sexual orientations -- it could be a boon to their sex life and to their masculinity, or it could be a very scary thing for themselves, for their health, for their society. I’ve met quite a few men through my interviews who really reject Viagra and what it represents for our society, which I was surprised, but heartened, to see.

MJ.com: What about women?

ML: Women are all over the board just as men are, [although] women’s voices are much more difficult to find on this, because it’s seen as a masculine phenomenon. But we know from advice columns that probably half of women in heterosexual relationships where their partner is taking Viagra—they are not happy with it and they would prefer to work on communication, or else they would prefer to not be sexual beings. Then you have another half that are raring to go in terms of finding their own female Viagra and are upset that that isn’t more prioritized in the world of science. And then there are women and men who are part of critical activist groups who are saying, “This is a symbol of our culture and I don’t like what it represents.” Across the board, it’s much more complex than the pharmaceutical companies have led us to believe.

MJ.com: What are the prospects for a female Viagra?

ML: Female Viagra is still considered the next blockbuster drug. If they can find something that responds to women’s needs, that’s where the complexity begins. Year after year I’ve been attending these conferences on female sexual dysfunction, yet another diagnosis that seems to have come out of nowhere and this diagnosis is somewhat patterned after frigidity, but much broader. Just like Erectile Dysfunction it has a spectrum of worries or troubles or problems covering everything from problems with orgasm or arousal, to pain with intercourse.

Initially, the idea in the scientific community was that if Viagra works for men, then it should work for women; blood circulation must be the answer for all human beings. We can assume that Pfizer was quite interested in responding to that other half of the market. But in many, many, many clinical trials, women reported that yeah, maybe their blood was circulating to their genitals, but they weren’t feeling any increased arousal or desire or sex drive. So experts have gone back to the drawing board.

It’s still unclear—women are highly complicated. They show that visual slide at these conferences and say that men are very simple, it’s just about pressing a button on a machine [whereas] women are machines with lots of different knobs, and you have to twist a bunch of them different ways. They are highly complex. So that field is moving quite slowly, and it’s been much messier than the Erectile Dysfunction world. Of course the world of sexual medicine is probably at the very beginning. It’s been such a fruitful venture for now three pharmaceutical companies that I think we can anticipate more products on the horizon, more diagnoses that we’ve never heard of.

MJ.com: You apply sociologist George Ritzer's term "McDonaldization" to sex in America. What do you mean?

ML: McDonaldization refers to this idea that the ethic that underlies fast food has pervaded our culture and so even the realm of sexuality has become McDonalidized, meaning that we want to serve it up fast and hot, efficiently. So then the question is where is the nutritional value for our souls? If we reduce everything to performance, something is lost, and what we thought was normal becomes mundane. We are constantly striving for the unattainable. This is the Supersize trap. Some of the ads now, especially those for Levitra, play on the Supersize thing without using that term. The quality of the erection is what is most important. And the size of erection. So this can be a dangerous place to be where sex is mandatory first of all, the only way to achieve full personhood is by being sexually active and then, you know, the cult of efficiency is applied to our relationships.

MJ.com: You argue that Viagra can be seen as a way for older men to reassert waning dominance in a changing social hierarchy.

ML: Viagra taps into a cultural anxiety about masuculinity. Gender roles have changed quite a bit, there is quite a bit of confusion within relationships, within families, within the workplace, about men’s roles and women’s roles, about who is allowed to be sexual, who has the power in society. I encountered several men who and said, "You know, when I come home and my wife makes more money than I do, it’s helpful to have something like Viagra and to be in a traditional power position in the bedroom."

It's about much more than that, though. It also taps into our cultural anxieties about aging, about sexuality, these sorts of areas of identity that are changing. We are in an identity moment, where these postmodern identities can be aided with the help of medication now. It’s interesting to think about how identity and pharmaceuticals come together, particularly for younger generations.

MJ.com: How do you think it will affect younger generations?

ML: I think that it already is. I talked about men in their early twenties and the college students that I teach. You know this is in some ways the Ritalin generation -- many of these kids grew up with medicated childhoods. So they are using pharmaceuticals in new and different ways. They’re using it to construct new forms of selfhood and bolster particular identities. This isn’t everyone on the college campus, but there is a proportion of students who have no problem using psycho-stimulants for test-taking and a different class of drugs for partying. So pharmaceutical drugs are kind of the new drug of choice for elite institutions. It’s the new drug problem on campuses. Viagra is certainly part of that. We know of many cases, we spoke with people who work in Emergency rooms who see people who have taken X and Viagra, antidepressants and Viagra. It’s a new world of pharmaceutical cocktails. My concern there is that we are turning to pharmaceutical products rather than to one another. We are in such a biomedical moment that we tend to focus on our bodies only. I think people would benefit from looking at layers of life beyond their bodies.