Pill's cure-all image droops

By TIM WATKIN

Men's clinics in New Zealand have swung in behind the erection drug Viagra after warnings from a Harvard men's health specialist that it can cause as many relationship problems as it solves.

But the clinics have confirmed overseas reports that only 50 per cent of Viagra users refill their prescriptions.

The public debate surrounding the drug since its release five years ago received a new dose of controversy this week when Dr Abraham Morgentaler, a urologist at Harvard Medical School who helped with the implementation of Viagra, released extracts from his new book suggesting Viagra has created expectations it cannot fulfil.

In The Viagra Myth, he says: "Many of my male patients together with their partners have come to realise that finally achieving a great erection does not solve their relationship problems. In fact, it's frequently made them worse."

The drug had unforseen impacts on relationships - increasing the partner's sexual expectations, prompting infidelity, and ending relationships when the pill failed to re-ignite a couple's sex life as expected.

"People have come to expect that taking a little blue pill could solve their personal and relationship problems, no matter how complex those difficulties are."

Pfizer NZ media manager Chris Regan yesterday described Dr Morgentaler's warnings that Viagra isn't a sexual cure-all as "a statement of the bleeding obvious. It is not a panacea to relationship problems".

However, Pieter Watson, general manager of the New Zealand Men's Clinic, said patients here did not have the same unrealistic expectations as Dr Morgentaler's.

American men were quick to try new drug-based remedies as soon as they hit the shelves, Mr Watson said, and so men with less pressing needs might have tried and discounted the drug.

In New Zealand, men were still reluctant to face the stigma of erectile dysfunction. Only the most needy sought treatment and so outcomes were more positive.

Dr Chris Bulmer, of MensMed in Herne Bay, said the drug had helped men to talk more openly about sexual problems and its impact had been "overwhelmingly positive".

However, Canterbury University researchers Dr Annie Potts and Dr Tiina Vares welcomed Dr Morgentaler's warnings. "This is the voice that's been missing in the public arena. It's hugely important," said Dr Vares.

Results from their three-year study into the socio-cultural implications of Viagra, due to be released in November, revealed a complex and diverse range of experiences with the drug. The drug was not a success for everyone and often raised new relationship issues.

Some men found it didn't work and some reported decreased penis sensitivity.

But the biggest hidden impact was on the men's partners. Some were quite happy that their sex lives had come to an end and didn't welcome their partner's renewed vigour. Many weren't happy that their partner suddenly expected sex more often and feared for their relationship as a result. Five of the 33 men interviewed confirmed they had been unfaithful since taking the drug.

"They said it was like finding a new youthful masculinity. They could experiment. And it was something women worried about - that their partners would now stray."

She called on doctors to treat erectile dysfunction as a couple's issue, not just a man's issue.

Dr Vares said focus groups were concerned that publicity about Viagra - promoted by male heroes from Pele to Hugh Hefner and featured in television programmes from ER to Sex and the City - "peddled fear about erectile difficulties".

Mr Regan denied that Pfizer had encouraged publicity to boost sales.

"I don't think we've done well out of over-the-top reporting. We have done well out of having a medicine that's efficacious."

He said there was no way of knowing whether Dr Morgentaler's belief that less than half of all Viagra prescriptions were refilled was also the case in New Zealand, but Mr Watson and Dr Bulmer said that squared with their experience.

"But what the good doctor from Harvard is not talking about is the 50 per cent of people who are refilling scripts. Just think of all the relationships kept together because erectile dysfunction is solved," said Mr Watson.

His partner Dr Chris Paltridge said Viagra was often not the best solution for patients, but he was wary of Dr Morgentaler's suggestions that a 50 per cent refill rate meant the drug wasn't effective.

Although half had not refilled prescriptions, about half of those had gone on to other drug treatments. Others only ever needed one dose to kick-start their confidence and were never in the market for continued use.

"Yes, it can raise relationship issues," Dr Paltridge said, "but it certainly saves other relationships."