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偉哥問世 25 週年:人們對勃起功能障礙 (ED)態度的巨大

偉哥問世 25 週年:人們對勃起功能障礙 (ED)態度的巨大轉變

Arthur L. Caplan 博士 / 2023 7 18 / 評論 / Medscape

 

你好。 我是阿特·卡普蘭。 我在紐約大學格羅斯曼醫學院醫學倫理學部工作。

令人難以置信的是,25 年前,時任堪薩斯州參議員、前總統候選人鮑勃·多爾 (Bob Dole) 在國家電視台的一則廣告中討論了他性無能的事實。 你可能會想,「當時發生了什麼?這是傑里·斯普林格早期的經歷還是真人秀節目失控了?」。 不,今年的25 年前,偉哥被批准作為一種治療方法。

鮑勃·多爾被偉哥製造商輝瑞公司招募來拍攝廣告,在廣告中他討論了自己的性功能障礙。 他被招募是出於一系列非常具體的原因。 首先,他是一位傑出、傑出、受人尊敬的國家人物。 其次,他很保守。

也許你們不記得了,25 年前,當偉哥首次出現時,輝瑞公司非常擔心,他們會因向市場推出一種性藥丸來促進亂交而受到攻擊。 鮑勃·多爾基本上是在說,「我有一個健康問題。很難談論,但有一種治療方法。我要討論的事實是,我和其他許多人一樣,可以用它來解決這個問題」。

他被用來轉移那些擔心提倡婚外性行為的保守派或宗教批評家的注意力。 鮑勃·多爾也因與伊麗莎白·多爾結婚而廣為人知。這不是約會市場上的人,鮑勃·多爾是一個顧家的男人,他的選擇絕非偶然。 由於所有這些原因,鮑勃·多爾(Bob Dole)成為偉哥的第一位代言人。

現在,碰巧的是,我可以利用這種藥物發揮作用。 輝瑞(Pfizer)打電話給我,讓我去向他們諮詢這種全新療法的道德規範。 我從來沒有被一家製藥公司要求做這樣的事情。我不知道自己在做什麼。我想了想,說道:「如果你讓我參加你們紐約總部關於這種藥物的討論和會議,我就會這麼做,我想要能開放獲取」。

我想他們給了我開放獲取的權限。 FDA 批准偉哥之前,我參加了許多會議,並就如何推出它進行了許多討論。 當我到達那裡時,我堅持的一件事是他們必須治療一種疾病。 如果他們不想捲入對這個解決性功能障礙這個古老問題的新奇蹟上的批評,那麼陽痿 (impotence) 就不行,這不是醫學診斷,而且是一種非常不確定的情況。

答案是勃起功能障礙。 他們會見了泌尿科醫生、性專家和公司內部的個人,並提出了這樣的想法:如果您在嘗試了6 個月或更長時間後仍無法勃起,那麼您就患有勃起功能障礙,而這正是他們所針對的群體。應該推銷偉哥,我完全同意這一點。

發生的事情是,全世界可能有數億男性第一次站出來說:「我感到羞恥和內疚。我感到受到了侮辱。現在,我要對我的醫生說一些可能對我有幫助的事情,我有這個問題。」

這是一個非常重要的教訓,因為 25 年後,人們(男性和女性)仍然很難討論性問題、性功能障礙和性生活不愉快。 我知道我們在詢問這個問題方面已經做得更好了,但患者仍然很難深入探討、提出並談論它。 我們必須認真思考如何進行誠實、坦率的對話,讓人們感到舒服,以便他們可以告訴我們。

偉哥向世界證明的一件事是,性功能障礙不僅大量存在(有些 65 歲以上男性的比例高達 35%),而且性功能障礙與疾病有關。它是由高血壓、動脈硬化和糖尿病引起的。這可能是由心理焦慮引起的,甚至可能是由於關係不好而導致事情破裂造成的。

我認為重要的是,當偉哥首次出現時,輝瑞試圖做的事情以及圍繞它進行的營銷是將其視為一種疾病,試圖將勃起功能障礙視為一種症狀,然後嘗試探索該症狀的潛在可能原因。

可悲的是,如果我們今天看,我們已經走了很長一段路——而且並不總是一條好路——從偉哥的起點開始。偉哥很容易在網上買到。 許多公司說,只要上網,醫生就會和你討論處方。 他們確實這麼做了,但他們不再在網上探索可能導致勃起功能障礙的根本原因。 他們當然可能會有一個複選框,並向某人詢問這個或那個,但我已經測試了這些網站,你可以在大約 30 秒內獲得處方。

伴隨偉哥出現的舊醫療模式並沒有真正消失。 我們現在把它當作一種娛樂性藥物或春藥,但這些都不是真的。如果你的身體運轉正常,血液就會流到該去的地方。服用偉哥或任何其他治療方法都無助於改善或增強這種情況。

我今天看到的關於陽痿和勃起功能障礙藥物的另一個問題是,我們仍然沒有為女性開發出全套的干預措施。 確實,男人有偉哥,而且確實經常得到報銷。我們仍然有女性抱怨她們有性功能障礙或失去性興趣或任何可能的問題,而我們還無法開發出可以幫助她們的藥物。

自偉哥 25 年前獲得批准以來,直到 2019 年專利到期為止,該藥物的銷售額已達到 400 億美元。 它的廣告方式已經發生了轉變,現在可以在線播放並且幾乎可以按需提供。 我不確定這條路是否順利,但在這 25 週年之際,它提醒我們人們關心性。

醫生總是需要考慮探索這一點,並試圖對患者的健康狀況有一個願景或看法。 對於許多人來說,如果他們在床上遇到問題,仍然很難說出來,我們希望確保我們盡力實現這一點。

總的來說,我認為25年前偉哥的批准是一件非常好的事情。 它把一個可怕的問題公之於眾。 它有助於提高許多男性的生活品質。不管我們今天的處境如何,我認為這種藥丸的推出實際上是藥理學的一項重大成就。

我是紐約大學格羅斯曼醫學倫理學部的阿特·卡普蘭。 感謝您的觀看。

以上表達的任何觀點均為作者自己的觀點,並不一定反映 WebMD Medscape 的觀點。

引用此內容:偉哥 25 年:人們對 ED 態度的巨大轉變 – Medscape – 2023 7 18 日。

 

 

25 Years of Viagra: A Huge Change in Attitudes About ED

Arthur L. Caplan, PhD / July 18, 2023 / COMMENTARY /  Medscape

 

Hi. I’m Art Caplan. I’m at the Division of Medical Ethics at NYU’s Grossman School of Medicine.

Incredibly, 25 years ago, Bob Dole, a senator from Kansas at the time and former presidential candidate, went on national television in a commercial and discussed the fact that he was sexually impotent. You might be thinking, “What was happening then? Was this an early Jerry Springer experience or reality TV gone haywire?” No. Viagra was approved as a treatment 25 years ago this year.

Bob Dole was recruited by Pfizer, the manufacturer of Viagra, to do commercials in which he discussed his sexual dysfunction. He was recruited for a very specific set of reasons. First, he was a distinguished, prominent, respected national figure. Second, he was conservative.

For those of you who don’t remember, when 25 years ago Viagra first appeared, Pfizer was terrified that they would get attacked for promoting promiscuity by introducing a sex pill onto the market. Bob Dole was basically saying, “I have a medical problem. It’s tough to talk about, but there is a treatment. I’m going to discuss the fact that I, among many other men, could use this to help that problem.”

He was used in a way to deflect conservative or religious critics worried about the promotion of sex outside of marriage. Bob Dole was also well known to be married to Elizabeth Dole. This wasn’t somebody who was out on the dating market. Bob Dole was a family man, and his selection was no accident. For all these reasons, Bob Dole was the first spokesperson for Viagra.

Now, as it happens, I had a role to play with this drug. Pfizer called me up and asked me to come and do a consult with them about the ethics of this brand-new treatment. I had never been asked by a drug company to do anything like this. I didn’t know what I was doing. I thought about it and said, “I’ll do it if you let me sit in on discussions and meetings at your New York headquarters about this drug. I want open access.”

I assume they gave me open access. I went to many meetings before the FDA approved Viagra, and many discussions took place about how to roll it out. Once I got there, the one thing I insisted upon was that they had to be treating a disease. If they didn’t want to get involved in criticisms about this new miracle solution to the age-old problem of sexual dysfunction, impotence wouldn’t do. It wasn’t a medical diagnosis, and it was kind of a very undefined situation.

Erectile dysfunction was the answer. They met with urologists, sex experts, and individuals within the company and came up with the idea that if you were unable to have an erection after trying for 6 months or more, you suffered from erectile dysfunction, and that was the group for whom they should market Viagra. I fully agreed with that.

What happened was that probably hundreds of millions of men worldwide came forward for the first time and said, “I’m ashamed and guilty. I feel stigmatized. Now, with something that might help me, I’m going to say to my doctor, I have this problem.”

It’s a very important lesson because 25 years later, it’s still difficult for people — men and women — to discuss sexual problems, sexual dysfunction, and unhappiness with their sex life. I know we’ve gotten better at asking about this, but it’s still difficult for patients to go into it, bring it up, and talk about it. It’s something that we have to think hard about how we bring forward, honest, frank conversation and make people comfortable so they can tell us.

One thing that Viagra proved to the world is that not only is there a large amount of sexual dysfunction — some numbers as high as 35% of men over age 65 — but that sexual dysfunction is related to diseases. It’s caused by hypertension, hardening of the arteries, and diabetes. It may be caused by psychological anxiety or even just a poor relationship where things are falling apart.

I think it’s important that when Viagra first appeared, what Pfizer tried to do and with the marketing oriented around it was treating it as a disease, trying to treat erectile dysfunction as a symptom, and then trying to explore the underlying possible causes for that symptom.

Sadly, if we look today, we have come a long way — and not always a good way — from where Viagra started. Viagra is easily available online. Many companies say, just get online and a doctor will talk with you about a prescription. They do, but they don’t explore the underlying causes anymore online of what might be causing the erectile dysfunction. They certainly may have a checkbox and ask somebody about this or that, but I’ve gone and tested the sites, and you can get a prescription in about 30 seconds.

It’s not really gone with the old medical model that accompanied the appearance of Viagra. We now treat it as a recreational drug or an aphrodisiac, none of which is true. If your body is working properly, blood will flow where it’s going to go. Taking Viagra or any of the other treatments will not help improve that or enhance that.

The other problem I see today with where we are with these impotence and erectile dysfunction drugs is that we still have not developed a full array of interventions for women. It’s true that men have Viagra, and it’s true that that’s often reimbursed. We still have women complaining that they have sexual dysfunction or loss of interest or whatever the problem might be, and we haven’t been able to develop drugs that will help them.

Since Viagra’s approval 25 years ago until the patent ran out in 2019, $40 billion worth of the drug has been sold. Its advertising has shifted so that it’s now online and available almost on demand. I’m not sure that path has been good, but it is a reminder to us, in this 25th anniversary year, that people care about sexuality.

Doctors always need to be thinking about exploring that and trying to get a vision or a view of the health of their patients. It’s still hard for many people to speak up and say if they’re having problems in bed, and we want to make sure that we try our best to make that happen.

Overall, I think the approval of Viagra 25 years ago was a very good thing. It brought a terrible problem out into the open. It helped enhance the quality of life for many men. Despite where we are today, I think the introduction of that pill was actually a major achievement in pharmacology.

I’m Art Caplan at the Division of Medical Ethics at NYU Grossman. Thanks for watching.

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: 25 Years of Viagra: A Huge Change in Attitudes About ED – Medscape – Jul 18, 2023.

 

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