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One Billion Pills Later


Since Viagra was introduced in 1998, approximately one billion pills have been sold. According to its manufacturer, Pfizer, an average of three pills have been dispensed each second that it’s been on the market. And an estimated 35 million men worldwide have used it. [US News & World Report, March 27, 2008]

Unfortunately for Pfizer and other manufacturers of FDA-approved drugs designed to address impotence, its revenue erection seems to be softening. The revenue of the big pharmaceutical companies from U.S. (as opposed to international) sales of drugs treating what is euphemistically called “erectile dysfunction” seemed to have peaked and now is in decline.

Mike Huckman, CNBC’s health beat financial analyst, recently questioned: “I wonder if the weak American economy is causing men to cut out Viagra from their budgets. Or maybe more of them are cutting their pills in half.” No one would question whether during a period of economic uncertainty, with debt, foreclosure and unemployment figures rising, men’s erectile organ should be falling. [CNBC, July 25, 2008]

The decade since Viagra was introduced marks a most peculiar era of American male masculinity. In was an era in which a real Yankee cowboy, a character from a bad made-for-TV movie, acted out on the world stage the false masculinity that only Viagra can induce. Unlike a TV cowboy, this one had real power and misused it.

The most perverse demonstration of Bush’s false masculinity was when he jumped from the cockpit of the Navy S-3B Viking and, posing against a banner that proclaimed “Mission Accomplished”, strode assertively across the deck of the USS Abraham Lincoln.

Here is an iconic image like Roosevelt meeting with Churchill and Stalin at Yalta, Kennedy huddled over the Cuban missile crisis or Reagan at the Berlin Wall, Bush-the-Lesser (as Arundhati Roy calls George W.) will be forever immortalized in his fetishistic Top Gun get-up. Imitating Tom Cruise imitating a John McCain fly-boy, America’s Viagra president strutted about in a high-tech nylon-poly jumpsuit. Like the super-stud captain of a small town Texas high school football team, Bush symbolized masculine potency, the president as hard-on.

Yes, America has had a leader who is tough and assertive, willing to employ preemptive, penetrating power. Unfortunately, as we all know and all Viagra users’ experience, he is a leader displaying the same fictitious masculinity that, when the rhetorical rage of patriotism, imperialism and Christian crusade ebbs, will, like a Viagra hard-on, shrink to reveal his true, pathetic natural manhood.

Now, as the ’08 election approaches, one can only hope that if the McCain-Palin ticket looses, we shall soon see John and Sarah, like Bob Dole a decade ago, appearing together in a Viagra commercial.

* * *

Viagra is part of a class of drugs known as PDE5 inhibitors (phosphodiesterase type 5 inhibitor) that restricts the enzyme that regulates blood flow in the penis. It enhances the hardness and duration of an erection. Perhaps most appealing to many men, it increases the ability to achieve a new erection shortly after achieving ejaculation. In fact, once a man takes a little blue bill, the erection is involuntary and cannot be reduced until the drug wears off. Among some of Viagra’s principle competitive FDA-approved drugs are Cialis from Lilly and Levitra from Bayer (GlaxoSmithKline).

According to the Johns Hopkins Bloomberg School of Public Health, in 2007, more than 18 million men in the U.S. suffered from erectile dysfunction. Impotence is a complex phenomenon involving physiological and/or psychological factors. Physical factors range from disabilities (e.g., injury to the penis), drug reaction (e.g., to beta-blockers), hormonal system imbalance (e.g., testosterone production) and circulatory system malfunction or vascular problemes (e.g., blood flow). Pyschological factors range from stress (e.g., work, income), fear of causing pregnancy, unresolved sexuality or identify issues and fear of having a heart attack during sex. And then there is self-medication, the drug and alcohol abuse which are among the leading causes of impotence.

In 2000, Forbes reported that Viagra took off faster than any drug in history, racking up some 3 million prescriptions in the first three months on the market. In 1999 the drug had worldwide sales of $1 billion.

Viagra is a pharmaceutical-industry solution of a simmering crisis of male masculinity that emerged in the wake of the ‘60s-‘70s counter-culture and women’s movement. According to Angus McLaren, author of “Impotence: A Cultural History,” a new form of impotence was discovered in the 1970s. “While the old impotence affected tired, older men bored with their middle-aged partners,” he observes, “the new impotence was purportedly experienced by younger men increasingly daunted by the demands of sexually liberated women.” [New Scientist, April 28, 2007]

Popular acceptance of a pharmaceutical solution to impotence can be dated to Bob Dole’s 1998 appearance on the CNN Larry King show. While the show focused on the former Senator’s prostate-cancer operation, during a commercial break King supposedly asked Dole, mano-y-mano, how he was handling the sexual consequences of the surgery. Dole admitted he was part of a Pfizer clinical trial of a wonder drug that solved all his problems.

The drug quickly became a social status symbol, the capitalist master-of-the-universe could now sport, like his high-priced car and trophy bride, a perpetual erection. Like his latest marketplace triumph, all asserted his virility. So quickly did it become accepted within mainstream male culture, Alan Greenberg, chairman of Bear Stearns, donated $1 million to finance Viagra prescriptions for other, equally needy men.

According to the National Institutes of Health, the majority of men suffering from erectile dysfunction are age 65 or older. In the Massachusetts Male Aging Study conducted in 1987-1989 about erectile potency, more than half (52%) of men aged 40 to 70 reported some form of impotency, with complete impotence at between 5 to 15 percent. So real is complete impotence that approximately 25,000 men annually undergo penile implant procedures. Nevertheless, one can only wonder if anything has really changed with regard to male plumbing in the decade prior to Viagra’s introduction and the decade since? [“Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study,” Journal of Urology, January 1994]

If, as likely, nothing physiological has changed, one can only assume that something other that bodily necessity drives the Viagra craving. America is a society lubricated by drugs. We rely on a host of drugs to get through the day, whether caffeine or cocaine, Prozac or Ritalin, meth or mary-jane, ecstasy or alcohol, RU-486 or Viagra.

The obvious public secret is that Viagra sustains a man’s erection whether he is diagnosed suffering impotency or not. While senior citizens in retirement communities could get Viagra on Medicaid prescription until January 1st, 2007, a growing customer base among younger men, both straight and gay, who like the sustained erection it provided.

Urban party-going young men use it as part of an erotic drug-fest. Known as “poly-pharmacy”, the taking of a handful of different party drugs, these drugs help counterbalance the different altered states induced during a night on the town. Taking Ecstasy or Special K (Ketamine hydrochloride) often kills the sex drive as does alcohol and cocaine. For serious party players, Viagra solves one problem. It allows a guy to party, in every sense of the word, all night.

A recent report in the “International Journal of Impotence Research” found that “there was less use [of Viagra] for medical necessity.” The principal researcher, Tom Delate, found that Viagra “use increased 312 percent in men ages 18 to 45, while it rose 216 percent among men 46 to 55 years old.” He also found that men 56 and older continued to receive the majority of Viagra prescriptions. [HealthDayNews, August 5, 2007]

* * *

The last decade has been a period of sex scandals and Hummers, of a War on Terror abroad and culture wars at home. The same year that saw Viagra introduced was witness to the grand spectacle of Bill Clinton’s denials and impeachment. But ’98 also brought revelations of the Navy Tailhook scandal and the adulterous liaisons by such upstanding, moralistic Congressmen as Henry Hyde, Dan Burton and Newt Gingrich. Now, a decade later, the recent scandals, from Mark Foley and Larry Craig to Eliot Spitzer and John Edwards, may mark the appropriate bookend to the Viagra era.

Men have long been traumatized by a fear of impotence. While some men (and women) have been unable to conceive off-spring, the inability to have an erection has a different historical resonance. Since the Greeks, Western men have turned to a host of natural aphrodisiacs, rituals and prayers, hormonal treatments and mechanical devices and a growing number of scientific (and pseudo-scientific) drug to address the problem. Unfortnately, with Viagra and other PDE5 inhibitors, erection becomes an end in itself and impotence is reduced to, in McLaren’s words, a “fixation on penetration”.

Now, the mantra of penetration seems to be softening. The Viagra-induced erection symbolically represented in the domestic culture wars and in preemptive imperialist intervention seems to be declining. As this happens, a deeper crisis of masculity is being revealed. One indication of this apparent develoment is reflected in CNBC’s health analyst Huckman’s observations about the sales of PDE drugs. Pfizer’s revenues are shrinking, Bayer’s are flat and Lilly’s reflect flat sales but increased pricing. This loss of revenue is, ironically, coming at the same time that GM seems to have decided to sell off its Hummer division. Together, they suggest that the era of false masculinity, most symbolically embodied in America’s cowboy president, may be coming to an end.

DAVID ROSEN can be reached at

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David Rosen is the author of Sex, Sin & Subversion:  The Transformation of 1950s New York’s Forbidden into America’s New Normal (Skyhorse, 2015).  He can be reached at; check out

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