At an American Urology Association conference in Las Vegas in 1983, 57-year-old Giles Brindley brought attention to impotence research by exhibiting that old age wasn't preventing him from getting it up.
For his presentation, Brindley was to demonstrate the effectiveness of injectable drugs in treating impotence. Naturally, he injected himself with the drug he was presenting, commanded the stage, threw off his pants, and proudly showed off his erect penis. "I was wondering why this very smart man was giving his talk in a jogging outfit," a conference attendee told Fortune. "Then he stepped from behind the podium. It was a big penis, and he just walked around the stage showing it off."
About fifteen years after Brindley's dong flash, Pfizer found other attention-grabbing researchers to back their new drug,Viagra. Their story illustrates why the most amazing thing about Viagra is not its propensity to turn derelict dicks into steel-hard ramrods, but rather its effectiveness in providing a conduit for big pharma to distort America's perception of sexual dysfunction.
On its journey from birth to billions, Viagra's marketing was powered by research from consultants on its parent company's payroll. These experts were presented to the public as nonpartisan researchers who just so happened to find that sexual dysfunction was widely pervasive in America. Although self-serving research is common in the pharmaceutical industry, Pfizer's success with yielding research to convince people they need this particular drug is an outlier.
A major reason doctors began frantically dishing out Viagra is because a 1994 study by recognized sex experts Edward Laumann and John Gagnon found that between 30 and 50 percent of American adults complain of sexual dissatisfaction. Laumann later expanded on this study and claimed that 43 percent of women and 31 percent of men were sexually dysfunctional.
These studies enabled Pfizer to claim that, in the late 1990s, 30 million men in America suffered from "erectile dysfunction," which is the euphemism the company used to broaden the disease's reach beyond its elderly base. What makes these figures ludicrous is that, just a few years prior to Viagra's release, pharma companies pushing injectable impotence products claimed that 10 million to 20 million American men were impotent. A little language twist coupled with sponsored research nearly doubled the target population. Pfizer was able to expand the market for its product to the point that Viagra was theoretically on the table for one-third of all adult men.
Around that same time, urologist Irwin Goldstein was promoting the idea that "impotence should be considered as a major health concern." Goldstein became a medical celebrity as Time, the New York Times, Playboy, and Good Morning America broadcasted his opinions on impotence without much questioning. Goldstein told the press Viagra was "a dream [that] practitioners in this field didn't think possible" and "the start of an exciting revolution." Goldstein, Laumann, and other charismatic researchers on company payroll legitimized the drug to the public by openly talking about sex with authority and telling them impotence was a serious dysfunction that should be treated with pills.
Within just a few months of its release, Viagra made nearly half a billion dollars in sales. Pfizer was so bullish about its cock pills that it named the drug the "official sponsor of Valentine's Day"—an interesting brand move considering that only a short time before, impotence was generally understood to be a condition that primarily affected elderly men. An article in the trade publication Pharmaceutical Executive summarizes the exuberance behind Viagra's marketing:
"Now, how many people knew ten years ago that there would be such a term as erectile dysfunction? That's brilliant branding. And it's not just about branding the drug; it's branding the condition, and by inference, a branding of the patient. …What kind of patient does a blockbuster create? We're creating patient populations just as we're creating medicines, to make sure that products become blockbusters."
These same studies estimating high rates of sexual dysfunction have been used in recent years to promote new libido-enhancing products like pills and injections aimed at boosting women's sexual desire. The influence of the consultants' studies is easy to spot because media coverage relies on tired stats to imply that in the US at least 30 million men and 50 million women are sexually dysfunctional, which is coincidentally the same figures drug companies promote on their websites.
It might be easy for anyone skeptical of consumer culture to view these studies as flawed, but the researchers behind them do not always have a malicious intent. When journalists have asked Goldstein about his ties to pharma companies, he does not deny his connections or get defensive. He just doesn't see his relationships with drug companies as a conflict of interest.
"Serving as a consultant to pharmaceutical companies helps me ensure that the research they're performing or [the] results they're interpreting match what we in the field understand about women's sexual function," he told Mother Jones.
But while researchers can provide valuable experience and information to help drug companies better understand diseases, it becomes much more difficult for them to stay objective once they're on the big pharma payroll. "It's not so much that the industry is there in some Machiavellian way," psychiatrist David Healy told Mother Jones. "But if you spend an awful lot of time with pharmaceutical companies, if you talk on their platforms, if you run clinical trials for them, you can't help but be influenced."
According to a Fortune article, pharma researchers sign nondisclosure agreements that prevent them from "divulging data that might conflict, say, with a company's carefully crafted statements about new drugs." Some of these researchers even invest in the companies they're consulting for, which creates conflicts of interest that are usually hidden from the public.
So it's not terribly surprising that academic research backs up Healy's theory of subtle collusion: A meta-analysis found that 98 percent of studies conducted by drug company–sponsored researchers supported the drug in their study, while researchers without drug company sponsors supported the drug in their study about 20 percentage points less often. Research has also shown that doctors who receive money from pharma companies are more likely to prescribe those drugs and request that the drugs be added to their hospital's list of medications.
Through relying on clever marketing and researchers who had connections that were unclear to the public, Viagra sales surged. Which isn't all bad considering that for many people—particularly the elderly—the pill did improve sex lives. But what is often unrecognized, as copycat impotence drugs proliferate and Pfizer extends their sponsored research internationally, is this: The way our culture views sexual dysfunction is based on parameters set by drug companies whose main interest is pushing as many pills as possible.
This post was adapted from The Sex Effect, a new book by Ross Benes out this week. Follow him on Twitter at @RossBenes.