I helped Pfizer think through the ethics of Viagra 25 years ago | Hacker News Reader

I helped Pfizer think through the ethics of Viagra 25 years ago

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All of the supposed ethical issues seemed like nonissues to me. Like higher rates of STDs among the elderly doesn't sound like an ethical dilemma for Pfizer, but rather on the elderly to practice their new ability safely.

This was the 90s. It was a much different time and social conservatives had a much louder voice than they do today.

Even Democrats were against same sex marriage back then.

It was a stroke of genius to have Dole as a spokesmen. He was seen as a conservative and an elder statesmen that everyone respected on the left and the right.

One thing that puzzles me about erectile disfunction drugs, it's why did it take such drugs so long to be invented/discovered. For many common conditions, traditional medicine in various cultures managed to find effective treatments hundreds or even thousands of years before modern pharmacology (think chinchona tree bark for malaria, or willow tree bark for pain, that in due time would originate quinino and aspirin). But for erectile disfunction, it seems every traditional treatment before Viagra was completely bogus (think quail eggs or rhino horn powder). Why?

I wonder if some of those traditional treatments benefited from the placebo effect for ED caused by non-physical maladies.

Is there any known natural remedy for ED?

If not, that could be the entire explanation.

You should direct your questions to the spirit of departed Chinese emperors. 'Did it work, o son of heaven?'

https://en.wikipedia.org/wiki/Tiger_penis

Btw, per wikipedia, the discerning Chinese older gents now reach for Viagra instead of the cherished member of the male tiger. Pfizer earned a lot of tiger-karma points right there, I bet they are grateful. /g

I just saw chili peppers being advertised as "natural Viagra" today in Amalfi.

Promiscuous beautiful young yoga instructors would probably be a healthier alternative in the long run

Its discovery was a complete accident.

Originally the drug’s intended use was lowering blood pressure through nitrous oxide mechanism.

This causes blood vessels to dilate making them wider and reducing pressure.

Fun fact: erections in humans are not caused by blood being pumped into the penis, but rather by a sphincter that inhibits flow of the blood into the penis relaxing, I.e. opening up to allow blood to enter.

This sphincter has a high affinity to this nitrous oxide mechanism.

A serendipitous side effect it seems…

Now, on to the answer to your question…

Prior to Sildenafil, the common recommended treatment was high doses of L-Arganine an amino acid which is available over the counter (which is used in Nitrous Oxide production, another was Amyl Nitrite - Yes the 70s Disco drug (and gay sex favorite) is also a vasodilator that breaks down to NO2 in the blood stream once inhaled - of course the action was fleeting, and there was a distinct possibility of fainting due to oxygen depletion.

So there were treatments prior to Viagra, but they weren’t necessarily efficacious or as long lasting as Viagra.

Yohimbine has been around for a long time and it fits that bill: https://en.m.wikipedia.org/wiki/Yohimbine

There are a few challenges. Knowing / testing that the remedy actually works as advertised. Identifying the active pharmaceutical ingredient (API). Isolating the API. Testing whether is safe to administer in its pure form. Purifying or manufacturing the API with sufficient yield and quality at scale. Formulating with other compounds to optimize pharmacokinetics (absorption, distribution, metabolism, and excretion). Testing whether the formulation of the API is effective. And then finally testing safety and effectiveness at scale. Also there are steps of figuring out how and why the API works. Failure at any one of these steps will kill development.

But it is not like this does not happen. Metformin is derived from French lilac. Just that it is much more difficult than it may appear.

I don’t think OP is asking why the pharmaceutical drugs took so long to come along. I think he’s asking why there weren’t traditional medicine solutions for ED before pharmaceutical.

I think the answer is that traditionally people were in better physical shape and more active - a huge amount of ED is caused by being out of shape, overweight, high blood pressure, etc. ED is the canary in the coal mine for a lot of physical (and mental) issues. On the mental side, I suspect people were traditionally less anxious than our modern society has made us.

Maybe there just weren’t any that worked very well. Once upon a time I had the privilege of seeing an FDA database of adulterated herbal / nutritional supplements; and the most common thing in there by an overwhelming margin was supplements spiked with Viagra. When I asked why I was told, “Man has searched for an aphrodisiac for thousands of years, and we finally found one.”

> I agreed to the job, requiring only that they pay my travel and food expenses, no stock, no pay.

Why would a professional take no compensation for their time when specifically sought out by the company?

I can understand taking cash only (in case of conflict of interest concerns), but I can’t grasp not taking pay in this situation.

As a side-side note it exists (or existed) a "testing device" that Pfizer provided to MD's to "assess" the patient's erection (EHS or Erection Hardness Score), here is a picture:

https://pbs.twimg.com/media/EfIXkmtVoAE5M5L.jpg

the blue buttons at the top are made of soft to increasingly harder gummy plastic.

> My most important advice, which I think is evident in the advertising campaign, was that the pill needed to target a disease.

This is huge. There are tons of people who believe in a "church and state" style separation between sex and society.

> In Israel, when the Knesset’s five-member science committee held a hearing on the drug, a witness passed around a sample box of eight Viagra pills. When the box came back, four pills were missing.

Let’s not forget that Viagra costs on average $70 a pill. It’s another case of the pharmaceutical industry gouging consumers because they can.

And we pay for it since insurance covers it.

Sticker prices aren't real prices when it comes to Rx drugs; for instance, GoodRx has 90x 20mg Sildenafil at Walmart for <$14.

This is because the patent has run out and you can now get generic.

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