No prescription ed pills

The perceived prevalence of ED needed to be expanded. The impression had to be created that ED was of significant concern to many, perhaps even most, men or at least those over 40 years of age. The criterion of success for treating ED had to be redefined. And finally, Viagra had to be seen as an important treatment option for men with any degree of ED, including rare or transitory failures to achieve or maintain erections. Redefining the Prevalence of ED and Its Psychological Effects. On its Web site, Pfizer states that “in fact, more than half of all men over 40 have difficulties getting or maintaining an erection” ( http://www.viagra.com/ed/index.asp).

The Web site does not give a reference to support this statement. One possible source of support for this statement is the Massachusetts Male Aging Study (MMAS), a community-based, random sample observational survey of men aged 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts [ 2]. The authors of the study extrapolated the results to argue that 52% of the entire male population in the United States between the ages of 40 and 70 suffer from ED. The authors stated: “In the MMAS sample the prevalence of impotence of all degrees was estimated at 52%. Projection of these results to 1990 population data would suggest that impotence affects 18 million American men 40 to 70 years old” [ 2].

However, the MMAS figures viagra online no prior prescription must be viewed with a number of caveats. First, there were actually two different groups of men in this study.

The first, and larger, group answered a series of nine questions about sexual activity.

The second, and much smaller, group answered the same nine questions, plus an additional question to self-rate themselves as not impotent,

minimally

The authors do not provide any information about whether the two groups were similar, and there are reasons to think no prescription ed pills that differences may exist between the groups.

The first group was randomly selected from towns and cities in the Boston Standard Metropolitan Statistical Area [ 3], while the second group was made up of men presenting to a university center urology clinic [ 2]. Even if the scores from one group can be transferred to the other, the 52% figure is still deceptive because it doesn't differentiate ED by age. In the MMAS, 40% of 40-year-old men had ED, including 17% who were only minimally impotent, whereas 67% of 70 year olds were impotent. Moreover, not all studies are in agreement with these figures.

Analysis of data from the US National Health and Social Life Survey indicates that among men 50–59 years old, 18% complained of trouble achieving or maintaining an erection during the past year [ 4].

A survey in the Netherlands found that only 1% of men 50–65 years of age had a complete inability to achieve an erection, and it was only in men aged 70–78 years that the rate of ED was similar to that in the MMAS [ 5].

Out of 13 studies on the prevalence of ED that were published until June 1998, the MMAS

results

Thus, Pfizer's statement that “more than half of all men over 40 have difficulties getting or maintaining an erection” does not reflect the large variation in the prevalence of ED found in different studies.

The MMAS found a strong association between ED and psychological factors, including “depression, low levels of dominance, and anger either expressed outward or directed inward.” The authors suggested that psychological symptoms might be a cause of ED, but these symptoms could also be an effect of ED (they wrote that “a man who has experienced a recent pattern of ED may be expected to be anxious, depressed and lacking self-esteem and self-confidence”) [ 2].

While not to deny that there is an association between ED and psychological symptoms, once again the MMAS may be an outlier. In the Dutch study previously mentioned, only one-third of all men and only 20% of men over the age of 70 with significant ED had major psychological concerns.

Furthermore, in sexually active men, 17%–28% had no normal erections, indicating that full erectile function is not essential for sexual functioning [ 5]. Only 20% of Japanese men 40 to 79 years of age reported more than little worry and concern about sexual functioning, suggesting that perceptions of elderly male sexual function and its impact on health-related quality of life may differ among cultures and ethnic groups with differing values [ 6].

On its Web site, Pfizer states: “VIAGRA can work for you. In fact, studies show that VIAGRA works for more than 80% of men with ED taking VIAGRA 100 mg versus 24% of men taking a sugar pill” ( http://www.viagra.com/whyViagra/highlyEffective.asp).

The 80% success rate that Pfizer quotes for Viagra is important, though not critical, to being able to promote its use to a wide variety of men.

But that number is qualified on the Pfizer Web site as the number who experience improved erections ( http://www.viagra.com/consumer/aboutViagra/index.asp). It is open to speculation whether the goal of most men is improved erections, or successful intercourse and the achievement of an orgasm.

In most studies on Viagra, a 50%–60% rate of successful intercourse is recorded (in the dose titration studies reviewed in [ 1] for patients taking placebo, up to 25% of attempts at intercourse were successful compared with 50%–60% for patients taking Viagra 25–100 mg).

This 50%–60% rate is far short of the “more than 80% of men” that Pfizer trumpets.

To make Viagra into a lifestyle drug, Pfizer needs to convince men that it is the first choice for therapy for any degree of ED, whatever the genesis of the problem. However, drug therapy may not always be the most appropriate treatment option. The National Health and Social Life Survey data indicate that emotional and stress-related problems such as a deteriorating social and economic position generate elevated risk of experiencing sexual difficulties. In these cases, Viagra may be less important than counseling or help in finding a new job.

These possibilities are never mentioned on the Viagra Web site.

Here is a sample of the questions and answers on the “About ED” portion of the Web site: Question: “I don't have ED because the problem doesn't happen often.

Does this mean that VIAGRA is not for me?” Answer: “Even if erection problems happen only once in a while, VIAGRA can help. You should know that most men with ED only experience problems some of the time.

In one study, VIAGRA helped 87% of men with mild-to-moderate ED have better erections versus 36% of men taking a sugar pill” ( http://www.viagra.com/faqs/faqs2.asp).

In case the message is missed, there is a couple on the Web page where the man looks to be in his mid-to-late 30s.

Pfizer reinforces its message with direct-to-consumer magazine ads, such as one featuring a virile looking man around 40 saying, “A lot of guys have occasional erection problems.

I chose not to accept mine and asked about Viagra.” Drug companies have identified lifestyle drugs as a “growth market.” The initial television ads in the US for Viagra used an aging Bob Dole (born 1923) as a spokesman, a 1996 Republican presidential candidate. Since then, Pfizer has refocused its advertising buy viagra with prescription campaign to match the lifestyle message on its Web site.

There is now advertising of Viagra at NASCAR races, and Pfizer hired 39-year-old Rafael Palmeiro, a former Texas Ranger baseball player as a spokesman ( Figure 1 ) [ 7]. Pfizer teamed up with Sports Illustrated magazine to create the Sportsman of the Year Trivia Game ( http://www.viagra.com/sports/index.asp).

Between 1999 and 2001, Pfizer spent over US$303 million in direct-to-consumer advertising to get its message about Viagra to men [ 8–10].

Besides the large promotion budget, Pfizer has also paid a number of doctors to act as “consultants,” delivering public lectures and appearing in the mass media to expound on ED and Viagra [ 11] Pfizer denies that it is targeting younger men or that it is positioning Viagra as a lifestyle drug.

Mariann Caprino, a spokeswoman for the company, is quoted in the New York Times as saying, “Have we gone out and given our advertising agency instructions to speak to this young population?