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Happy 20th Birthday to Viagra, the Accidental Boner Pill That Changed America

Bob Dole's magical pill changed the way Americans think about sickness and treatment.

Bob Dole's erectile dysfunction ads, paid for by Pfizer, sent American men to their doctors in droves.Bob Dole's erectile dysfunction ads, paid for by Pfizer, sent American men to their doctors in droves.Twenty years ago today, the Food and Drug Administration (FDA) approved orally administered sildenafil citrate tablets for the treatment of erectile dysfunction in the U.S., under the brand name Viagra.

The little blue pill, the most popular use of which was discovered by accident, helped change how prescription drugs are marketed, and shifted public perceptions of what drugs can and should do.

It was also an instant hit. Within two months of going to market, "approximately one million prescriptions had been written in the U.S. alone," according to a 2005 paper in the International Journal of Clinical Practice.

But Pfizer Inc., the company behind the drug, had bigger ambitions for Viagra, which was the first treatment of its kind for erectile dysfunction. The company wanted to hit $1 billion in sales during its first year of availability, but was on track for only $800 million by December of 1998. To close the gap, Pfizer hired one-time GOP presidential candidate and former Sen. Bob Dole (R-Kans.) to serve as pitchman for the drug.

Dole, then 75, was perfect for the role. A social conservative from the midwest who'd served in World War II, Dole acknowledged in May of 1998 that he'd participated in Viagra's clinical trial to treat the "impotence" he experienced as a result of undergoing surgery for prostate cancer in the early 1990s.

"It is a great drug. I'll be honest. I was in the protocol and participated in the program," Dole said during a live appearance on CNN's Larry King Live. "There are many men out there, millions of men out there, who suffer from impotence, and this may be the first step."

Various stories provide different explanations for how Pfizer learned sildenafil citrate worked better in the male member than the heart. In 2008, NPR told this story:

Pfizer was testing it as a cardiovascular drug for its ability to lower blood pressure, but it raised something else, earning it the nickname "the Pfizer Riser." So how did the researchers find out? Well, the apocryphal story goes, you can take this or leave it, the trial subjects who took the drug for its original purpose, they wouldn't give back the samples.

Last year, Quartz unearthed this story:

All seemed to be going well—except for one weird thing the men enrolled in the study did when nurses went to check on them. "They found a lot of the men were lying on their stomachs," John LaMattina, who was the head of research and development at Pfizer while this research was ongoing, said on a 2016 episode of the STAT Signal Podcast. "A very observant nurse reported this, saying the men were embarrassed [because] they were getting erections." It appeared that the blood vessels dilating were not in the heart, but rather the penis.

When Viagra went generic last year, Bloomberg's Joe Nocera noted its cultural impact thusly:

Viagra was the first drug to allow impotent men to maintain erections. That made it the first true "lifestyle" drug and showed the pharmaceutical industry that there was money to be made developing drugs that improved people's lives without curing disease or alleviating pain.

If creating a lifestyle drug was the first innovation, selling one was the second. Traditionally, companies sold drugs by having salespeople persuade doctors to prescribe them. But that wouldn't work for Viagra; doctors were as reluctant to ask patients about their sex lives as anyone else. The only way doctors were going to prescribe Viagra in large quantities was if patients asked for it.

Dole's ads became a "textbook case in condition branding," Colgate University's Meika Loe told NPR in 2008. That model—in which direct-to-consumer ads "educate" patients about the symptoms of a disease they often didn't know existed as part of promoting a branded treatment—is now the lifeblood of the drug industry.

It's probably one of the biggest reasons why prescription drugs that both work and feel good—narcotic sleep aids for insomnia, benzodiazepines for anxiety, amphetamines for ADHD, and testosterone for "Low-T"—saw their prescription rates increase dramatically over the last two decades, in lockstep with diagnoses of the associated conditions. Patients recognized some of their (ambiguous and/or common) "symptoms" in advertising, and knew exactly what to ask their doctor for when they went in to talk about it. Condition branding has also been used to "create" new diseases in order to find a use for compounds that don't otherwise have an obvious application.

Is condition branding bad? Did Pfizer and Dole open Pandora's Box? Many policy wonks have come to see the pharmaceutical information ecosystem as toxic, thanks in no small part to the role of physician-targeted marketing in the opioid crisis. But I'm skeptical that ads play the same role today, or that they are more bad than good. Between online social networks and drug and disease forums, pharmaceutical ads don't have near the informational monopoly they once did. It's also easier than ever before to check what a pitchman tells you against the available scientific evidence.

I also think we are bad at acknowledging the impact of things we cannot measure. When it comes to drugs, we can measure how much they cost and the rates of consumption, hospitalization, and death. We are less good at—and perhaps less interested in—measuring how drugs improve people's lives.

Regardless, Dole talking about his erectile dysfunction helped shift the Overton Window. He made it easier for American men to both accept that they were experiencing a problem they could not think their way out of and to seek an effective remedy. Yes, the success of Viagra helped drug companies develop a wildly profitable new advertising model. But I don't see that as a net negative if it paved the way for a social ecosystem in which more people talk about, and get help for, ailments like depression, anxiety, acne, and obesity; in which we feel free to talk openly with each other and our care providers about things like family planning and oft-embarrassing autoimmune disorders like IBD and plaque psoriasis.

As with every other aspect of modern life, the prescription drug landscape is not perfectly unproblematic. But as Viagra proved 20 years ago, "right now" is always the best time in history to have a medical problem.

Photo Credit: Mark Blinch/REUTERS/Newscom

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  • BigT||

    ""right now" is always the best time in history to have a medical problem."

    No. Years from now or never are even better.

  • Juice||

    in history

    Years from now

    hmmmm

  • Fist of Etiquette||

    I couldn't concentrate enough to fully get all the information in this post. Honestly, this has never happened to me before.

  • Rich||

    Did Pfizer and Dole open Pandora's Box?

    Oh, FFS, Mike!

  • XenoZooValentine||

    If you find yourself in Pandora's box for more than four hours, you should both stop and get some sleep for once.

  • Libertymike||

    Bob Dole says Bob Dole gets it up like Bob Dole always has.

  • Chipper Morning Baculum||

    Did you hear he was sad that the twin birth coaches were handing out Asian dogs in the valley?

    Bob Dole's dole deals with the dual dale doulas duly doling out dholes.

  • Hugh Akston||

    Does this mean that Viagra is off patent now?

  • NoVaNick||

    I suspect that if Viagra or its likes were never discovered, most of us never would have heard of Stormy Daniels. Also, I wouldn't see so many dads who could easily be grandpas at my kids' school.

  • Detroit Linguist||

    One could make the claim that birth control pills are also a lifestyle drug (which makes them much older than ED drugs). After all, what is the purpose of birth control pills? To permit 'normal' sexual intercourse without fear of pregnancy. But one can have a perfectly satisfying sexual relationship with another person without engaging in 'normal' penis in vagina sex, so birth control pills are merely a way of permitting one kind of sexual behavior. That strikes me as just as much a lifestyle issue. In fact, it's an argument for why the Pill should not be any more subsidized than Viagra, since it's not essential for sex--it merely makes one kind of sex less risky.
    FWIW, this isn't an argument I've seen made elsewhere.

  • Leo Kovalensky II||

    "But one can have a perfectly satisfying sexual relationship with another person without engaging in 'normal' penis in vagina sex,"

    You've proven yourself to be a

    *dons sunglasses*

    cunning linguist

  • StackOfCoins||

    I doubt I'd be perfectly satisfied with handies and bjs. Not that I'd turn them down, either. Just saying.

  • Leo Kovalensky II||

    Your forgetting anal-ternative

  • Leo Kovalensky II||

    *You're.... christ

  • Telcontar the Wanderer||

    Here at HnR, such things are beneath us.

  • The Laissez-Ferret||

    A 100% guaranteed birth control method.

  • Finrod||

    As a friend of mine once said, "When I was in high school, anal sex WAS the safe way to have sex".

  • Diane Reynolds (Paul.)||

    All seemed to be going well—except for one weird thing the men enrolled in the study did when nurses went to check on them. "They found a lot of the men were lying on their stomachs," John LaMattina

    FACT: If I'd have been enrolled in that study, it would have looked like I was floating in midair.

  • Telcontar the Wanderer||

    I'll call Dr. Venkman.

  • Libertarian||

    Just read that Pfizer is planning to sell Viagra OTC in the UK.*

    *OTC in the UK is true -- not an abandoned John Cougar song.

  • Eidde||

    The spokesman for Viagra should have been John Boehner.

  • Libertarian||

    Nah. Nancy Pelosi's husband. They would have made $2 Billion.

  • Telcontar the Wanderer||

    It wasn't worth endangering their brand with a false testimony.

  • Inigo Montoya||

    Nah. I'm pretty sure viagra only works if you feel some arousal to start with. So I think Mr Pelosi would be better as a spokesman for a drug that brings about blindness and deafness.

    But I'm not sure there'd be much market for a Helen Keller pill.

  • BestUsedCarSales||

    Nope. You'll get a boner regardless.

  • TCMann||

    Actually, if I recall, it was this woman that made the announcement that Viagra had been approved by the FDA

    https://bit.ly/2IYyTRF

    Seriously

  • Juice||

    It was twenty years ago today
    That Viagra passed the FDA
    It's been going in and out of style
    But it helps your boner last a while
    So may I introduce to you
    My little chubby maker dressed in blue
    Sgt. Stiffy's lovely hardon clan

  • Mr. Dyslexic||

    Sergeant Pecker!

  • Juice||

    Shit. You're right. Mods, please edit...

  • Juice||

    Also remove "little".

  • SQRLSY One||

    You beat the Beatles, Dude!!! Way to go!!!

    Now, what else can U beat?!?!?

  • SQRLSY One||

    Kerry Becker,
    The Hairy Pecker,
    And his thirty-six,
    Dirty dicks,
    Stage name Willy, Willy, Whippin' Free,
    Playin' at Chippendales, for her & she,
    Always needs his little blue pill,
    'Cause he's gettin' over the hill!

  • StackOfCoins||

    Bravo.

  • SQRLSY One||

    OK, so, then, we are all agreed… Good job!

    It was twenty years ago today
    That Viagra passed the FDA
    It's been going in and out of style
    But it helps your boner last a while
    So may I introduce to you
    My chubby maker dressed in blue
    Sgt. Pecker's lovely hardon clan!

  • SQRLSY One||

    But now, what about Jack and Jill? Don't you know Jack?!? He's feeling neglected, sad, and blue!

    Jack and Jill,
    Went up the hill,
    To see what they could see.
    Jack got over the hill,
    So needed his little pill.
    Now Jack and Jill,
    Both on the pill,
    Got carried away,
    In the light of the day!
    She offered her honor,
    He honored her offer,
    And all day long,
    It was honor and offer!

    (A music video to go along with this could be a YUUUGE hit!)

  • Rich||

    "Easy, Boy" should have been "Down, Boy".

  • Libertarian||

    Number one, I'm incredibly impressed with your encyclopedic grasp of pop culture references.

    Number two, I'm shocked at my own capacity for feeling nostalgic about a 16 year old commercial, and the relative innocence of such a recent period.

  • JeremyR||

    To me what's bad about Viagra is basically it turned a pill mostly used for recreation into something that the government buys for people

    It's a great pill. But people should buy it with their own money, not taxpayer dollars

    And it's also a bit hypocritical that drugs that basically cut out the middleman to give you pleasure are illegal, but viagra is perfectly acceptable

  • Diane Reynolds (Paul.)||

    A boner is a human right.

  • Telcontar the Wanderer||

    Positively!

  • Vernon Depner||

    Even for men with vaginas?

  • Vernon Depner||

    The woman with whom the patient intends to have sex should have to provide her written enthusiastic consent to the pharmacist before Viagra is dispensed. Otherwise, it's rape.

  • Ornithorhynchus||

    Prescription drugs being marketed directly to consumers had been around for a decade or so before Viagra. I can remember plenty of ads for Rogaine/minoxodil (which required a prescription at the time), acid-reflux drugs, and nicotine patches, all telling people to talk to their doctors about them. Like impotence, these are all conditions which people didn't usually ask for medical help with at the time.

    Viagra may've helped popularize condition-branding, but it'd been around for awhile already.

  • Eidde||

    One pill makes you larger
    And one pill makes you small
    It's the pills the Pfizer gave you
    That let you do it at all

    Just ask Bob Dole
    When he's having a ball

  • DenverJ||

    Pretty good. Better than the Beatles one upthread.

  • Eidde||

  • Telcontar the Wanderer||

    I have the most accidental boner right now.

  • SIV||

    I'm just happy get a cash rebate every time I get free Viagra while women pay more for a month of birth control than a median-price home mortgage payment. Once you factor in male privilege it's more than fair.

  • Eidde||

    Speaking of things that are stiff...

    "Student activists at Hofstra University (in New York state) are demanding the removal of a statue of Thomas Jefferson from campus....

    "The protest is co-sponsored by a number of campus organizations: Campus Feminist Collective, Collegiate Women of Color, Democrats of Hofstra University, Hofstra History Club, Hofstra NAACP Chapter, Peace Action Matters, Queer & Trans People of Color Coalition, Student Advocates of Safer Sex, The Gender Identity Federation, The Pride Network of Hofstra University, and Young Democratic Socialists of Hofstra.

    "When reached for comment, the organizers pointed to the event description.

    ""Jefferson's values aided in the construction of institutionalized racism and justified the subjugation of black people in the United States," the petition reads, alleging, "Jefferson has been embraced as an icon by white supremacist and neo-nazi organizations such as the Ku Klux Klan and online white supremacist chat rooms…""

  • Telcontar the Wanderer||

    The only consolation here is that every time this happens, we come one step closer to it reaching FDR and LBJ.

  • BestUsedCarSales||

    You know. I'm surprised it hasn't gotten to Wilson yet. Considering he was a vile racist and all that.

  • Telcontar the Wanderer||

  • Eidde||

    Speaking of penises, guess what might get banned in Iceland?

    "Icelanders might be on the fence about the legislation, but religious leaders are unanimously opposed. Davíð Tencer, the Catholic Bishop of Iceland, recently came out with this statement: "To us, it looks like this can be an opportunity for those who are interested in this matter to misuse the subject of circumcision in an attempt to persecute individuals for their religion." Davíð's views echo those of Agnes M. Sigurðardóttir, the Bishop of Iceland, who condemned the ban early on. "The danger that arises, if this bill becomes law, is that Judaism and Islam will become criminalised religions," she said."

  • StackOfCoins||

    "The danger that arises, if this bill becomes law, is that Judaism and Islam will become criminalised religions"

    Two things: One, from what I've heard second-hand from a Rabbi, circumcision is not mandatory to have a convenant with God.

    Secondly, maybe your religion shouldn't making cutting baby dicks a rite of passage.

  • Telcontar the Wanderer||

    "What I've Heard Second-Hand From A Rabbi" was my first Pulitzer-nominated novella after I graduated.

  • Vernon Depner||

    Opposition to circumcision is heteronormative.

  • Eidde||

  • SIV||

    America's WORST President

  • Chipper Morning Baculum||

    We could have gotten such a head start on Pleistocene rewilding.

  • Telcontar the Wanderer||

    Better to wait for cloning technology to get its shit together so that we can have the version that doesn't need tusk enhancement drugs.

  • Vernon Depner||

    Accidental Boner would be a good...well, you know.

  • Eidde||

    ...sequel to The Accidental Tourist?

  • Finrod||

    I saw Accidental Boner open for the Bonzo Dog Doo Dah Band once.

  • Sevo||

    "A very observant nurse reported this, saying the men were embarrassed [because] they were getting erections." It appeared that the blood vessels dilating were not in the heart, but rather the penis."

    Hell, I'd have hoped *she* (assuming a female nurse) noticed.

  • Anton456||

    Viagra pills completed successfully 20 years to serve hard erection in impotence men. Before 20 years erectile dysfunction or impotence problem seems like an ashamed thing in men, but after that FDA approved Viagra 100mg medication and men get a happy sexual life.
    Nowadays, plenty of men use generic Viagra 100mg pill to overcome erectile dysfunction (ED) and most of the doctors suggested this medication to people.

  • uunderstand||

    Delivery; 10-15 working days

    She won't wait that long. Uhh, I meant she won't wait.

  • raymondclara||

    Am Clara Raymond from USA I was in trouble when doctor told
    me that I have been diagnosed with HIV/AIDS… I
    thought about my Family, I know my Family will face a
    serious problem when I'm gone, I lost hope and I wept
    all day, but one day I was going the internet I found
    Dr Idahosa email. I emailed him and he guided me. I
    asked him for solutions and he started the remedies for
    my health. Thank God, now everything is fine, I'm cured
    by Dr Idahosa herbal medicine, I'm very thankful to Dr.
    Idahosa and very happy with my hubby and family.
    email him on idahosaherbalhome@gmail.com or
    what_sapp him Tel- +2347033330164

    DOCTOR IDAHOSA CAN AS WELL CURE THE
    FOLLOWING DISEASE:-
    1. HIV/AIDS
    2. HERPES
    3. CANCER
    4. SINGLES
    5.HEPATITIS
    6.E.T.C

  • Murray Rothtard||

    thank god.

    i have been battling a crippling case of E.T.C. for decades. calling now...

  • Árboles de la Barranca||

    He can't cure cure SPAM, so he's a quack.

  • Anomalous||

    What's up with Viagra?

  • No Longer Amused||

    My wife's uncles used to show people at family functions their stash of Viagra and brag of all the "little hotties" they were doing at the local brothel.

    I don't think they really needed a celebrity endorsement in some parts of the world.

  • Earth Skeptic||

    If you like your erection, you can keep your erection...

  • Mrs. Premise||

    I was a pharmacy tech when Viagra came on the market, and at the time the popular ED drug was something called Muse, a penile suppository. About six months after Viagra came out, the Muse drug rep came in and told us that due to the popularity of Viagra, Muse sales had petered out...

  • Robert||

    That made it the first true "lifestyle" drug and showed the pharmaceutical industry that there was money to be made developing drugs that improved people's lives without curing disease or alleviating pain.


    Uh, birth control pills? Antiperspirant? Minoxidil? Anesthetic, if you use it for cosmetic surgery?

  • Nuwanda||

    Schwing!

  • celina jolly||

    I was cured of HIV with the used of natural herbs. My name is celina jolly and am from US. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured 8 months ago, i suffered from HIV for 13 yrs but with the help of Dr.Ogun herbal medicine, i was cured within few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as i heard she had herpes, i quickly refer her to Dr.Ogun and she was cured too after drinking his herbs.I have referred more than 15 persons to Dr.Ogun and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Ogun now, he is a herbalist doctor, i assured you of a cure if you drink his natural herbs. Dr.Ogun have herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, HBP, STD, cancer, chronic, etc. Contact Dr ogun through his Email address on: drogun62@gmail.com or WHATSAPP/CALL him on+2348104991149 . Please share the good news to other people once you are cured.

  • painkillersman||

    We are top suppliers Marijuana, pain pills, sex pills and anxiety meds available (we have meds like xanax, tramadol, percs, oxy, roxy, valium, actavis syrup, etc... +1 (724) 470-0553. Call: +1 (419) 299-6124
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  • painkillersman||

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    Email Us Via : discreetsales2015(@)gmail.com

  • Lesa Thomas||

    Generic Viagra is safe and effective erectile dysfunction treatment for men of all age groups. Get quick delivery for over the counter Viagra drug now. Say no to mild hardens, and achieve a hard erection for around 4 to 6 hours by just receiving Viagra for sale at your doorstep. We promise the best quality of generic viagra online.

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