HIGH PRICED SEX

I remember when Viagra first came out and sold at $8 a pill.  Men complained of having to pay $48 for six pills.  This was in 1998.  It currently sells for $300-350 for six pills.  Or $50-60 per pill.  There's much complaining going on, one man calling it a travesty.

Recently, a super nice elderly gentleman came in, acting and looking like he was 42, lamenting over the high price of Viagra.  He couldn't afford it.  He happens to be married to a vibrant and active woman who is fifteen years his junior.  Call him Ralph.

Ralph brings in a piece of paper, a note, reminding him to share and educate his doctor about what his buddy had recommended to him.  And that is that there's a drug called Revatio, which has sildenafil, the same active ingredient in Viagra.  His buddy received a prescription for Revatio from his doctor and he said it worked just fine.  It comes in 20 mgm tablets at the maybe affordable price of $20 per pill ($120 for six pills).

Revatio is approved for treating adult pulmonary hypertension (constricting high blood pressure of lung arteries) because sildenafil relaxes arterial muscle allowing it to dilate, or open more, increasing the flow of blood through constricted arteries, improving a person's exercise capacity.  But Revatio is not FDA-approved for treating Ralph's problem, erection dysfunction.

The prescribing of Revatio for erection dysfunction, or for that matter anything other than its legally FDA-approved use in pulmonary hypertension, is considered technically to be prescribing "off label", meaning, technically that it's being prescribed for a medical condition for which it has not been tested.  This is very interesting because the sildenafil in Revatio is the same darn sildenafil in Viagra!

Prescribing "off label" is common with many medicines and is generally accepted in the medical community -- but only on days outside a court of law, when everyone's in love, and it happens to be a sunny day.  For in the case of an adverse event, of any kind, that either disables you with a stroke, finds you in the grave with a fatal heart attack, or brings on disabling migraines, then the prescribing doctor is subject to getting a surprise that will come in the form of a subpoena from a lawyer representing an unhappy opportunistic family member who's been looking for a way to cast off the yoke of too many debts.

Since we know lawyers advertise on TV and in print almost daily, seeking to represent people who've experienced known side effects from FDA-approved medication, it's not unreasonable to believe they would almost certainly sue for bad outcomes on medicine prescribed "off label" for a condition that's not FDA-approved.  Especially for a drug that does not remedy a life-threatening problem and is viewed as not absolutely necessary.  To wit, the phentermine fiasco!

Now this seems to be a very sad thing to do to a vibrant, healthy, poor man like Ralph who's only wish (and his wife's too) is to have all his tools in good working order.  Ralph picked up on this.  He said well if the same generic active ingredient that's in Viagra (sildenafil) is the same as the active ingredient in Revatio, why doesn't the FDA approve the Revatio for erection dysfunction since it has the exact same sildenafil, in a lower dose, as what's in Viagra?  Plus, the damn thing's already been tested!  This is a good question.  He said, "Is it because of the drug company that makes Viagra?"  I told him in my opinion I think drug companies probably are politically influencing the FDA drug approval board, on which sits interestingly-connected characters, in subtle and not so subtle ways.

In fact, Ralph complained about it being a "quality of life" issue and proffered a nice metaphor saying his situation was like having a nice, thick, juicy steak placed before him and he sits there with the utensils ready to eat, but with no teeth.

But as hard as it is for men to accept the high price of Viagra, which has only gone straight up, there's a bursting light at the end of this shaft.  The good news is that the patent for Viagra will run out in December this year and there will be two generics of Viagra coming on the market in December.  They would have come out earlier last year but according to the word on the street, Pfizer, the maker of Viagra, purportedly paid off the companies to delay it until this year.

Till then, men without health insurance who are unable to afford the skyrocketing price of Viagra will have to make do somehow.  Or, the alternative, as you reach for a stiff drink, is to find a town without lawyers, or unhappy people, and a doctor who's wily and brave enough to prescribe this particular drug "off label" -- sad as that might be. 

May we all be delivered from high-priced drugs!

Merry Christmas and Happy New Year!