by John M. Curtis
(310) 204-8700

Copyright March 15, 2002
All Rights Reserved.

victim of its own success, Pfizer's little blue pill finds itself back in the hot seat, now blamed for causing increases in sexually transmitted diseases. Approved in 1998, Viagra revolutionized treatment of impotence, boasting $1.5 billion in sales in 2001. San Francisco Public health officials, citing fresh data linking Viagra to increases in gonorrhea, asked the FDA to post new warnings. "The data is clear, the evidence is strong," said Dr. Jeffrey Kausner, director of San Francisco STD control and chief author of a new study blaming Viagra for causing risky sexual behavior. "There's really at this point no excuse for inaction by the FDA or the manufacturer," said Kausner convinced that warning labels would prevent exposure-risks. Admitting that young gay and bisexual men often use Viagra recreationally together with illicit drugs like methamphetamine, ecstacy, and amyl nitrate [AKA "poppers"] Kausner got his wires crossed concluding that Viagra leads to increases in STDs. More realistically, risk-takers and drug abusers engage in unsafe sex.

      Taking Kausner's findings in stride, Pfizer's Viagra spokesman Geoff Cook offered a more benign explanation: "Any pharmaceutical product can be abused, and that's beyond our control." But it's unclear at whether Viagra leads to unwise sexual behvavior—with or without abuse. Approved for increasing genital blood flow, risky sexual behavior involves much more than vasodialation, including specific lifestyle choices. Drawing participants from the gay community, Kausner shouldn't generalize beyond his sample. Even extending findings to gays mixes up cause and effect. Abusing prescriptions or illegal drugs doesn't cause unsafe sex, any more than eating French fries cause obesity. Clearly, personal choices account for aberrant behavior more than prescribed or illicit drugs. Pfizer stands by its current warning label regarding STD transmission: "Viagra does not protect you or your partner from getting sexually transmitted diseases, including HIV—the virus that causes AIDS."

      Asking for new warning labels won't stop impulsive behaviors—whether it's drug abuse or unsafe sex. Kausner's findings are reason for alarm, but not about specious "side effects" from Viagra. "Nobody should think that by taking Viagra they can be protected," said Cook. "Clearly they need to engage in safe sex," suggesting that personal responsibility has more to do with STDs than using Viagra. Kausner found among his gay and bisexual sample that Viagra users had 10% more STDs than non-Viagra users. He also found that over a two-month period Viagra users had nearly two more sexual partners than non-Viagra users. Here's where Kausner goes over the deep end. Simple correlations say nothing about cause and effect. Viagra didn't cause gay and bisexual individuals to be more promiscuous—but promiscuity and reckless behavior might cause greater Viagra use. Kausner also found that gays were four times more likely to use Viagra than heterosexuals, proving, if nothing else, that sexually active gay men have different sexual patterns than their straight counterparts.

      When Pfizer rebuffed Kausner's overture, he petitioned the FDA to modify Viagra's warning label. Agreeing with Kausner, Los Angeles County STD director Dr. Peter Kerndt noted frequent recreational Viagra use in the gay community. "That's where the real risk is," said Kerndt. "When it's used recreationally and combined with other drugs like methamphetamine or ecstacy," that's where Viagra can lead to unhealthy sexuality. With greater demands, Viagra supplies the extra octane needed to sustain more sexually aggressive lifestyles. Viagra's performance-enhancing effect allows sexual partners more stamina than they would ordinarily have. Despite Viagra's medical use for the treatment of erectile dysfunction, it's difficult for physicians to define precisely individual needs. While difficult to gauge, it appears that gay men engage in more free wheeling sex, requiring more performance-enhancing drugs like Viagra. With more sexual contact come more STDs—at least for those practicing unsafe sex.

      Fingering Viagra doesn't shed light on key lifestyle factors that lead to sexually transmitted diseases. Until there's scientific proof, epidemiological studies can't show convincing cause-effect relationships. Sure, Kausner found more STDs with certain groups using Viagra. But that's a far stretch from proving that Viagra puts users at greater risks for contracting STDs. "What he's attempt to do is definitely laudable," said Dr. Vince Silenzio, assistant professor at Columbia University Medical School. "But on the other hand, we don't know what's going on yet, so it's a little premature to issue specific warning about what's causing it," cautioning not to leap to conclusions over Kausner's study. It wasn't long ago that research supported by the Church of Scientology blamed Eli Lilly's popular antidepressant medication Prozac for causing suicidal behavior. Creating a media hubbub, the FDA found no reliable evidence linking Prozac and suicide. While noteworthy, Kausner's findings about the relationship between Viagra and STDs seem equally doubtful.

      When it comes to sexuality, there's no substitute for personal responsibility to assure healthy lifestyles. While there's no doubt that Viagra enhances blood flow, it doesn't cause reckless behavior leading to sexually transmitted diseases. "Let's place the blame where it lies. It's not fair to target a pharmaceutical company because people find a legal method to cope with an illegal problem," said Kevin Hunt, admitting that he was prescribed Viagra to counteract impotence from using methamphetamine. It's not Pfizer's fault that physicians sometimes overstep their bounds at the behest of needy patients. Nor is it physicians" fault that diagnosing and treating ambiguous conditions like erectile dysfunction is based almost entirely on patients" subjective testimony. Whatever the community, it's difficult to know exactly what constitutes sexual dysfunction. National statistics won't satisfy individual urges or, for that matter, the sexual demands of cin fast-paced lifestyles. Fingering Viagra grabs great headlines but doesn't solve problem of personal responsibility.

About the Author

John M. Curtis is editor of OnlineColumnist.com and columnist for the Los Angeles Daily Journal. He's director of a Los Angeles think tank specializing in political consulting and strategic communication. He's author of Dodging The Bullet and Operation Charisma.

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