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May 6, 1998
Viagra, the Pill That Could: For a Doctor, It Brings Writer's Cramp
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Insurers Set Conditions on Paying for Impotence Drug (April 29) Doctors Debate Use of Drug to Help Women's Sex Lives (April 25) Pfizer Drug for Impotence Leads Market (April 21) Impotence Drug Expected to Be a Popular Pill (March 28) FDA Approves Pill to Overcome Impotence (March 28)
By N.R. KLEINFIELD
IVINGSTON, N.J. -- Beginning another day on the front lines of what he refers to as "Viagra madness," Dr. Stanley Bloom, urologist and impotence specialist, flexed his hand to steel it against writing cramps.
Men's redemption from sexual malfunction was exacting its physical toll on his already ragged penmanship. So many craved a prescription for the little blue Pfizer pill that was sweeping the country, but how much could a 60-year-old right hand take?
Some urologists had acquired stamps to apply their signature on Viagra prescriptions. Bloom had his nurse prepare a tidy stack of prescriptions in advance. Then he authenticated them the old-fashioned way as the men tumbled in.
"I'm burning out," he lamented as the chronically jammed waiting room of his Physicians in Urology offices on East Northfield Road emptied into the hive of examination rooms, though he was sincerely gratified to see a breakthrough against an affliction that consumes his practice.
In trooped the patients, something like 25 a day in the last three weeks for the diamond-shaped miracle pill, extending Bloom's daily office hours three hours beyond the norm.
Reflecting the very height of exuberance and expectation, John Dowling, 69, a retired packaging foreman for Budweiser, only half-jokingly asked for a prescription for 1,000 pills.
"They're $10 apiece," Bloom replied.
"Five hundred, then?"
"That's $5,000. You've got to be kidding."
He settled for 20.
It was already his second prescription. He had been in two weeks ago and had tested the pill five times, with gratifying results. He said an intermittent impotence problem struck two years ago and had worsened.
"It was affecting me mentally," he said. "I couldn't perform as a man. My wife and I would be at each other's throats for no reason. This Viagra has brought me back 20 years. I can't praise it enough. I love sex -- no ifs, ands or buts. It's back."
He was entirely unruffled by the uncertainty of the drug's long-term side effects. "Listen, I'm 69," he said. "How much long term do I have?"
It is going this way, day after frenzied day, in urologist office after urologist office across the nation. In the month since Viagra reached pharmacies, everyone from robust young men in their teens to wobblier ones in their 90s has been insisting on the pill that could.
Here in Livingston the other day, the stories varied. The solution was identical.
A lawyer, 44. Taking an injected drug for "erectile dysfunction" for two and a half years.
Viagra.
New patient. Fifty-three-year-old male. Happily married for 27 years. ED for the last year.
Viagra.
A high school student. Insulin-dependent diabetes had left him impotent. On ED injections for two years.
Viagra.
"Impotence is a closet condition," Bloom said during a brief interlude from the madness. "It's estimated that it affects 30 million people. Doctors see half a million. Where are they? Now we're finding out where they've been."
He had expected eager interest. He is the medical adviser for an Impotence Anonymous group that convenes each month at the nearby St. Barnabas Medical Center of Livingston.
In April, when he gave a presentation on Viagra, he drew a crowd triple the normal attendance. Still, he has been struck by the clamor.
His nurse slid a phone message across his desk. Someone he had not seen in three years desired a Viagra prescription. He was too busy to come in. Please call it in.
"This is what's going on," Bloom said. "But I won't do this over the phone, not with someone I last saw in 1995. I'm not a prescription writer."
He said he imagined that Viagra was going to be abused in every conceivable way -- people popping it five times a day; people sharing it with friends, wives, girlfriends; teen-agers seeking unimaginable thrills.
"I want to avoid patients giving it to anyone else by limiting the amount I will allow them," Bloom said. His early, self-imposed rules are 14 pills on the first visit -- that being the number that Pfizer included in its sample packs -- followed by a return visit in a month, after which he will authorize a three months' supply based on the patient's personal reckoning of sexual indulgence. Patients are then asked to get checkups at least twice a year.
The ethics of dispensing the nation's hottest drug are something each physician has to fumble with. In the white heat of the early Viagra fever, men without an impotence problem are seeking the pill in the expectation of enhanced sexual performance, though Pfizer has emphasized that it is not an aphrodisiac. Women suffering from sexual dysfunction are interested, but there is no scientific evidence of what, if anything, it could do for them.
"I've had several women call about it, and some of my male patients have said their wives have some problems, 'Could it be for them?' " Bloom said. "At this point I won't prescribe it for women. I want to see more information."
Impotence has its physical origins and its psychological ones. Before prescribing any medication, Bloom conducts a physical exam of a patient, sometimes going so far as to test things like penile blood pressure, vessel dilation and nerve conduction in search of a source of his problem.
But he acknowledges that he cannot always confirm impotence. Often, he must make judgments based entirely on a patient's word. "Someone could lie," he said. "I could be fooled. I probably have in the past. I don't think I've been fooled for Viagra."
A retired sales executive, 73, beckoned in the front examination room. Trying to do three, four things at once, Bloom ducked in.
Bloom: "Basically, Viagra may be suitable for you and it's worth trying because it's a very safe medicine. I've gotten very good feedback. It's been three weeks and I've had people call and say they haven't had erections like this since they were 20 years old. It's incredible."
He recited possible side effects: stuffy nose, facial flushing, headache, slight drop in blood pressure, upset stomach, blue tint in one's vision.
Retired sales executive: "Whatever you say, Stanley. Let's give it a whirl."
He passed on to the doctor a Viagra joke: "So many elderly men have been taking it that they're changing the name of Sarasota, Fla., to Viagra Falls."
The blue pills are selling for $10 apiece in both 50-mg and 100-milligram dosages. Bloom started patients on the 50-mg version. Insurers are still having their own internal debates over what they will pay for, how much chemically induced sexual fulfillment is reimbursable and how much is not.
To help ease the financial outlay for patients, Bloom last week began writing prescriptions for 100-mg dosages and advising patients to chop the pills in half. That rewarded them with an instant half-price sale.
Who knows, though, how long a Viagra clearance sale can last. "We did that a while ago for a pill for prostate disease," Bloom said. "Then the company wised up and made it into a coated tablet that you couldn't break in half."
Finishing with one patient, he hurriedly dictated his conclusions into a handheld dictation device, talking so fast that he practically interrupted himself. He looked in on another patient, a 52-year-old actor, one of the first he had written a Viagra prescription for.
Actor: "Stanley, I'm three for three so far."
Bloom: "That's great."
He explained that his problem had visited itself gradually over a 25-year period. About 10 years ago, a leaky valve was determined to be the cause. Injections were recommended, but, he said: "I have a deathly fear of needles. So I lived with the problem miserably."
In just a week and a half, he was sold on Viagra. "It works," he said. "It isn't perfect. But it's certainly moved me back 10 or 15 years."
Bloom said he has heard of no significant side effects from anyone since the pill has been on the market. The actor recounted a slight ringing in the ears once and a slight stuffiness in his nose another time.
Of about 15 patients Bloom has gotten feedback from, all have reported success with the pill, though one said it did not deliver as well as injections.
The day wore on, Viagra on top of Viagra on top of Viagra. Writing, writing, writing. And then came the words the doctor had been waiting to hear from his nurse: "I think you're done."
"Thank God," Bloom said. "Made it through another day of Viagra madness."
Other Places of Interest on The WebDescription of the impotency drug, Viagra. Pfizer Inc..
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