CHAPTER 30

Homo Erectus

Dr. Ian Osterloh has asked to meet in Canterbury at the Old Gate Inn. The pub, dating from 1728, sits along a main thoroughfare on the path of the Pilgrims’ Way, heralded by Chaucer. As Osterloh sits in the back garden, sparrows dart and flit from the inn’s roof to the nearby geraniums. Just on the horizon looms Canterbury Cathedral, for years a home to honeybees—raised by Benedictine monks to generate income from the insects’ golden bounty. In a way, Osterloh is here to talk about the birds and the bees.

Osterloh, a physician-scientist with a mantislike presence, has been dubbed Dr. Viagra for his early role as the drug’s chief medical spokesman. His dark eyebrows are upturned in the manner of Flash Gordon’s Ming the Merciless. They offset a white shock of hair that sweeps across his balding crown. Now an independent medical consultant, Osterloh has an engaging air, a dimple, and a soft-spoken, almost courtly manner.

Today he is recalling his reservations about whether UK-92480 would have any effect at all on Clive Gingell’s band of volunteers. “We were cautious,” he says. “As researchers you can have a lot of false dawns.”

That is, until he got a call from the Bristol team. “Sam Gepi-Attee, the senior research registrar—who did the actual nuts and bolts of the study—phoned up and said, ‘You don’t need a statistician. This drug is working. You have to see these [RigiScan] tracings!’ He was excited. When the data came out, everybody got really excited because it was only a single dose and the drug was clearly working. Ten milligrams had some effect. But 25 was better. And 50 was better still. And the placebo had very little effect.” According to Larry Katzenstein, in Viagra’s so-called “blue book” (a concise official history of the drug’s discovery and launch), the registrar was even more animated when he informed Pfizer’s Mitra Boolell, telling him, “‘These patients are phoning me that they want more tablets and saying this has changed their lives.’ In fact, the patients’ partners were calling too.”

That spring, a small Pfizer team flew to a urological convention in San Francisco to present the company’s findings in a private conference room. And there was already some buzz. “[It was] at some ridiculous time in the morning,” Osterloh says, “at 5 a.m. or 6 a.m., at two breakfast meetings. We did it twice because these meetings are always overscheduled and packed.… Irwin Goldstein came up to me beforehand because he’d heard [rumors], and said, ‘Tell me, Ian. What is this drug? You can tell me! Tell me the mechanism action.’ I said, ‘I can’t. Wait till the meeting next morning.’ He said, ‘You can tell me.’ I said, ‘It’s vasodilation.’”

Goldstein has no recollection of that exchange, but the events of the morning remain clear as crystal to him. “I remember the day as I remember the day that I heard that President Kennedy was assassinated—and 9/11,” he offers in a phone conversation. “I can tell you every second of it. I remember walking up the hills of San Francisco to find this hotel. It was dusky. I remember registering. I remember sitting, listening to some British individuals, heavy accents, report that there was this agent that [prompted erections]. I recall specifically standing up, saying, ‘It’s not likely and not possible.’ I was very vocal. I said, ‘You have a certain amount of blood flowing around your body—around five liters a minute, every minute. But only about 10 milliliters [goes into] the genital tissues. It seemed impossible to get a drug that you took in the mouth that could end up in the penis affecting its functions when only around .1 percent of the blood was ever going to the penis.’”

“I remember the opposite,” Osterloh counters. As he tells it, Goldstein “broke into applause [when we finished] and said, ‘That’s the most interesting thing I’ve ever heard.’ That is my very clear recollection. Irwin was not playing the devil’s advocate. He’d been an enthusiast from the get-go.” (Goldstein begs to differ, insisting that not long ago he listened to a tape recording of the session.)

Whatever the case, most attendees were galvanized. “The enthusiastic response on the part of the [urology] community there validated that this was positive,” Osterloh says. “This was ammunition we could use [with Pfizer management] to further justify the next and very expensive stage of research. We had a few drinks that night—but not huge numbers [because we’d awakened] so bloody early in the morning. We went to have breakfast to celebrate.” Nick Terrett concurs: “The people who heard [the San Francisco presentation] just thought it was unbelievably incredible. My manager, David Brown—I remember him saying to me one day around this time, ‘You know, this could be the biggest drug that Pfizer will have in the future. If this goes the distance, this could be absolutely huge.’”

But they had to proceed gingerly. At this point they had only a couple dozen erections in hand.

The first Phase II study commenced, expanding the pool to 350 men in Scandinavia, France, and elsewhere in the U.K., with Bristol hosting additional tests. Many volunteers were resistant to the idea of placing guy wires on their willies. So Osterloh took on the task of creating a home monitoring system that was more user-friendly. He introduced a fifteen-item questionnaire—updating a template he’d seen at a conference—that ranged from the less tangible (“How would you rate your level of sexual desire?”) to the purely mechanical (In the past four weeks “how often were you able to penetrate your partner?”)1

The tests continued through 1995. At one point a clinician phoned to say that one of the subjects, accustomed to his nightly fix, had panicked when he’d been given a placebo. “The tablet has stopped working!” he insisted. “Another patient,” Osterloh would recount in Viagra, the Pfizer-commissioned chronicle of those early days, “reported that his wife got so angry when the tablets stopped working that she threw them into the fireplace.” In time, subjects would sneak pills for their friends or hoard them, claiming to have flushed their extra tablets down the john.

Finally, the results were presented at a pivotal meeting back at Pfizer research headquarters. Osterloh remained apprehensive. “I was beginning to feel a bit nervous,” he says. “I’d made the case for this compound for a while. I designed the study and we’d used a lot of instruments that hadn’t been used before. So all sorts of things could have gone wrong. The patients were older. They had more background medical conditions.

“We all gathered in one fairly small meeting room in Sandwich,” Osterloh continues. “I remember the buildup—the statistician, John Kirkpatrick, keeping us all in the dark. I remember the tension. And even when we all got there, John went through a lot of preambles. Eventually someone said, ‘C’mon, John, cut all this out. Give us the results.’”

Kirkpatrick’s results, Osterloh says, “were absolutely fantastic. We had a 90 percent response to the 50-milligram dose. Almost as high at 25. And almost as high for [a question posed to every respondent]: ‘If this treatment is available after the end of the study, would you want to continue taking it—Yes or No?’ Everything supported it: the diaries, the sexual function questionnaire [asking about] erection, ejaculation or orgasm, satisfaction, relationship-with-partner. They all went up.”

“Oh boy, oh boy, yes,” Peter Ellis now says, pulling another page from his file. “That study was [number] 353. People with psychogenic problems, no known cause, who take the tablets home doing normal things—we hope!” he chortles—“with their wives and partners. Typically, [a result] makes a few millimeters of mercury difference: you’re looking for a small effect in a moderate number of patients. These results were absolutely incredible!”

But it wasn’t time to celebrate just yet. “We’re a boring lot, us scientists,” Ellis clarifies. “There’s absolute delight and joy but not quite going-out-for-a-steak-dinner. This piece of data raced the mind ahead to the next hurdle. Whoopee!—fantastic!—next question. Will it work in patients with… diabetes, multiple sclerosis, hypertension, spinal cord injury?”

Over the next two years, the ranks of UK-92480 recipients would swell to some five thousand men in twenty-one studies in thirteen countries. And through it all, the data continued to be extraordinary: erections for three-quarters of all participants, including those with erectile dysfunction due to injury or a prevailing ailment. Most of the side effects were mild: nausea, headaches, flushing, clogged nasal passages. Some of the subjects spoke about an odd bluish tinting in their fields of vision. (Thus would the drug develop one of its many nicknames: the Blue Haze. Other tags: the V-Train, Vitamin V, “poke,” and the Pfizer riser.)

Though things seemed promising, the drug’s practical impact was lost on some members of the discovery team. Most of the UK-92480 scientists were in their forties or younger and had less of a real-world connection to a product intended for a more elderly demographic. But no matter. Pfizer’s CEO, Bill Steere, “was a bit older than us,” Simon Campbell says. “His friends told him there was a problem [with ED in their peer group]”; the senior set seemed ready, willing, and saleable. (Nine months after the drug’s launch, Steere would tell Newsweek that “no fewer than 20 of his colleagues running Fortune 500 companies are enthusiastic [Viagra] users.”)

Still and all, men with ED were an elusive group. The vast majority had never sought treatment. To meet the challenge, Pfizer, with Steere in the lead, went about the business of figuring out how to market a medicine with a largely unknown user base—and a potentially incalculable upside.

The drug, at this critical juncture, would now need a brand name. But how did the christening gods ever arrive at… Viagra?

Executives, so the story went, had settled on a word that rhymed with “Niagara” (think gushing waterfalls and blushing newlyweds) and one that began with a hard V (implying virility and vitality). “The press,” says Ellis, would eventually decode the name as having been derived from “the power of Niagara Falls, [and for] via, the Roman word for road.” One could make the case that viag implied vigor; ag and vie, aggressiveness; agra, fertility. There was also the view that the word evoked vagina, the male organ’s ideal hetero destination.2

What’s more, V turns out to be a potent letter in the pharmaceutical quiver. Lexicon-branding.com, in comparing Viagra to a subsequent competitor, Cialis, favors Viagra’s “prominent initial V as one of the fastest, biggest, and most energetic sounds [in the branding firm’s] sound symbolism research. As such, it sets the tone for the name, and hence the drug, to be also fast, energetic, and, in context, big.”

All of this, in the end, was poppycock.

For the real story, I contact David Brinkley, who would eventually steer the marketing plan for the drug. He confides that Pfizer, like many large companies, maintains a “name bank.” And during the interval when UK-92480 was being considered, there were two designations not yet assigned to products. One was Viagra. The other was Alond—like Almond, minus the M.

Viagra, as it happens, had previously been cleared as the name of a tablet intended to treat men with enlarged prostates, an alpha-blocker not dissimilar to a popular antihypertension drug called Cardura. The marketing team settled on Viagra as the name of the Cardura spin-off, says Brinkley, “partly because it sounded a little bit like Niagara—unstoppable flow of water. And it connoted, sort of, ‘big urination.’” But urologists and primary care physicians were already big fans of Cardura and they balked at prescribing a comparable drug with a different name. So Viagra was discarded and thrown back into the Pfizer hopper, along with Alond.

Both names had been vetted for copyright and trademark infringement. Both, insists Brinkley, had undergone “linguistic validation to make sure it doesn’t mean something weird in different languages around the world, or there’s no unintended meaning.” But which of the two was more appropriate to grace sildenafil, a tonic for erectile dysfunction?

The two names were proposed to Pfizer’s marketers and executives. “The opinion was fairly evenly divided,” Brinkley says. “Some people liked [Alond] because they thought it sounded like ‘elong,’ a little bit like ‘elongate.’ That sounded too weak for me. I just thought it sounded very soft, feminine, and—this will reveal the depth of my ridiculousness—it sounded like a French drug for women. Al-londe. Like Allons-y—[French for] ‘Let’s go.’ In the end, I kind of went with my gut, which is that Viagra was harder. Vs are very hard and masculine, and the G-R, the gruh, when you pronounce it, it comes out much more forcefully and much more hard-edged—and I thought that was a better brand image than Alond.” Niagara Falls and honeymoons, he claims, had nothing to do with the choice. “All of that stuff I used to read with great amusement. How we did it was: We went to the name bank. There were two names. There was a sort of eenie-meenie-miney-moe, and we settled on one that sounded more masculine.”

At first glance there is little in Brinkley’s background that would indicate that the father of two might be the ideal candidate to man Viagra’s marketing push. He had trained for a job in finance. He had earned a graduate degree from Johns Hopkins—in international studies. He had worked for the World Bank. Indeed, he looked like a banker (or, for that matter, a teller): lean, clean-cut, and boyish. At one point, he says, he even interviewed with the CIA.

When asked why he backed off from pursuing a job in espionage, he answers candidly: “Well, eventually I came out as gay. And back then you couldn’t get a security clearance if you were gay. In fact, that only changed with [practices under Bill] Clinton. I came out in ’91. I was ‘out’ when I was heading up the Viagra team.”

Brinkley explains that to his superiors his sexual orientation was a moot point. “Within Pfizer, which has a fair amount of Big Corporate America built into it,” he says, “we were a really eclectic team, really diverse ethnically, age-wise, demographically—with a number of rebels to take what was essentially an explosive topic and push some boundaries. That was one of the coolest things about it, actually. The woman who was head of market research is a PhD, vegan, third-degree brown-belt taekwondo Trekkie, who, like, goes off to Montana and Wyoming in the winter to stalk big cats.”

Even though the company, as Brinkley describes it, was “conservative and old-fashioned, they weren’t retrograde. Probably half of all the management were women, which in the late ’90s was still remarkable. My boss was a woman. The head of U.S. pharmaceuticals was a woman, Karen Katen.… It was very progressive with respect to religion—literally a United Nations of ethnicity and religion—only two or three blocks from the U.N. at 42nd and Second Avenue, with a large number of LGBT folks.”

In Brinkley’s view, and the company’s, he fit in just fine. “I had a picture of my husband—or my partner—and my children on my desk,” he says. “I took my partner to all corporate functions. We danced. We held hands. So it wasn’t a big deal. Did the chairman know that I was gay? Probably not. It probably never would have occurred to him.… But in the Pfizer culture I wasn’t wearing rainbow ties every day to work [or saying], ‘I’m here, I’m queer, get used to it.’ It was a very professional culture. We were still required to wear suits at the time—suits and ties, I don’t mean jackets and slacks.”

If anything, he says, his orientation might have been considered a plus. “I bring a lot of different [perspectives],” he says. “When it comes to sexuality, I think one of the good things is that I was married to a woman for quite a while and I have two kids and all. So I’ve been lucky enough to experience both sides of the sexuality coin.”

As the trials were due to be phased out, volunteers began clamoring to continue getting access to tablets. According to Pfizer’s own thumbnail history, Viagra, the company “received a deluge of letters,” recalled Richard Siegel, the firm’s then-senior medical director of sexual health. “A man had gotten engaged to be married while he was in the study, and he wrote that his fiancée was threatening to break it off if he stopped taking the medication.” Faced with many requests like this one, Pfizer made a decision early on to allow any test subject to receive the drug gratis as part of what is called an open-label extension.

“[The] patients in our trial used to send us letters,” says Brinkley. “We used to sit around in team meetings—the marketing group or the medical group—and take turns reading them. At the end of about five minutes’ worth of these letters, everybody on the team is sobbing. These were the most beautiful, heartfelt, heartwrenching letters I’d ever read. We talked with people who suffered from erectile dysfunction and we talked to their spouses. They rarely ever talked about [erections]. That’s not their language. That’s not their feeling. Almost invariably, and very quickly, they would take [the conversation] away from the physical act and describe what it was that was missing since they hadn’t had sex. ‘I miss talking. I miss cuddling. I miss intimacy. I miss making love to my wife. I miss being made love to’—or whatever it was. But it was rarely ever about having a hard penis.”

Indeed, one of Gingell’s volunteers from January 1995—a rare participant from the period of the Wales-Bristol trials who agrees to go on the record—speaks of Viagra as helping him in a deeper, spiritual way. Pravin Agravat is a single man from Leicester, England. In 1989, as a hospital catering assistant, he was pulling a portable food cart when it hit a slick of detergent on the floor and skidded out of control—and into his groin. Rendered impotent by the incident, which stanched his genital blood flow, he consulted specialists for years. Most, he says, told him, “You’re a young lad; don’t worry, we’ll get you back on track”—all to no avail.

Even so, Agravat recalls, one of his urologists told him, “Every time I’ve seen you, you’re smiling. Other men who come in here, they look really depressed.” With his beaming demeanor and Indian-inflected English, Agravat insists that he relied on his faith. “We have the Bhagavad Gita. The book says, ‘You are getting fruits from your actions. You get what’s destined.’ [In] my religion, how you see people, how you treat people, colors your attitude. So I had confidence that despite the injury and because I’m young, it would be okay.”

Sympathetic to Agravat’s condition, Clive Gingell agreed to take him on as an extra participant in the RigiScan studies. During the trial, Agravat had only minimal response to the drug. But once Viagra became available, his GP procured him some tablets. “Straightaway, I had a different reaction,” he says. “Within forty to fifty minutes, the blood started pumping, rapid, and for the first time in ten years I had normal penile responses. I looked down, and ‘Bing!’”—he pounds a fist into an open palm.

“Then, just the thought of the packet—there were four in a packet—got me excited. Within a couple of months, I [tried it] with a longtime friend… someone who understands me for three or four years. And she was more than happy to do it.” The results, he says, were spot-on. “The drug made me more fulfilled as a human being,” he attests. “And yet if Viagra had never come along, I would still have no regrets, even if I had never been able to have sex again. That’s because Viagra replaced only the avenue of sexual intimacy and did not alter my spiritual life, which was already rewarding and full, openhearted and simple and calm.”

Of his role in the Bristol studies, Agravat says, “I think I was destined to be in the study. We were pioneers in a way. Imagine if someone were taking nitrates and had a heart attack. No one asked me before the trials about a heart condition. We were risk-takers. There were all sorts of side effects. If it wasn’t for the people participating in the trials, there would be no Viagra.”

There was still major spadework required before a rollout. Launch teams were formed to do extensive research among physicians, consumers, and middlemen-providers.3 But how to anticipate the cultural and social reverberations of a pharmaceutical for erections? To that end, Pfizer set up the Viagra Issues Management (VIM) team, a core group of consultants. “The meetings were in New York,” Osterloh says. “On the panel was somebody specializing in psychiatry and psychology [with regard to] erectile dysfunction, a medical ethicist, a cardiologist, an ophthalmologist, [a specialist] in female sexual problems.” In addition, Pfizer canvassed experts versed in sociology, religion, sexual health, education, and the law. The company enlisted “University of Pennsylvania bioethicist Arthur Caplan to pepper them with hypotheticals,” as Newsweek’s Daniel McGinn and Anjali Arora would report. The range of topics considered: “What if nursing homes complain about requiring more private rooms to facilitate patient romance? Should Alzheimer’s patients receive the drug?”

Pfizer elicited early feedback from women’s organizations. “It’s a very delicate subject—male sexual function and penises and enabling sex and all,” Brinkley contends. “So [in] reaching out to women’s groups, [we stressed,] ‘We’re trying to restore something and actually create intimacy between couples—and that’s a laudable goal. What we’re not trying to do is make men, you know, super-potent heroes, where they’re out banging everything that moves.’”

What Brinkley and his colleagues didn’t foresee was the depth of the antagonism from those who viewed the drug in terms of sexual politics: as an offshoot of the men-centered worlds of Big Pharma and mainstream medicine. Many viewed Viagra as a restorative advancement designed not for the couple, as Pfizer was inferring, but for the man intent on having his way—no matter whether or not a companion clitoris came into play. In a chorus that would grow louder once the drug was introduced, these voices demanded to know why pharmacologists had not yet managed to perfect a so-called pink pill—the long-sought medicinal breakthrough that could facilitate or enhance female orgasm?4

The idea that Viagra was a he-man’s drug concocted by men for men—as an outgrowth of a male-dominated industry—is “pretty ridiculous,” Goldstein protests, an overlay of sexual politics on a medicine that sprang up organically from compelling physiological observations. “I think people who describe it in [these] terms are not part of the reality of history.… The drug Viagra and the term ‘erectile dysfunction’ emerged from individuals, including those in our own laboratories, that studied basic science.”

Meanwhile, Pfizer officials had to appease the group least likely to embrace the drug: the Vatican. On a trip to Rome, according to Ellis and Osterloh, a small Pfizer delegation made the case that Viagra would not promote values antithetical to those espoused by the church. “You can imagine, with the Catholic Church’s position on contraception,” says Ellis, “how they [might] view a drug that intervened in the normal reproductive process. Of course, Viagra would, in theory, facilitate procreation. Back at that time, Pfizer was aware that we were walking a tightrope between a drug for a serious condition, which could substantially enhance and enrich family life, versus the potential for drug abuse. So we were really focused on: this is a serious product… with real relationship benefits, [meant] for treating the couple and the family. The outcome was: it was endorsed by the Vatican.” (Pfizer executives, contrary to press accounts, did not have an audience with the pope, nor did the pontiff “bless” the pill.)

Liberation through medication had become the American way. A reliable erection, in effect, would soon become tantamount to an entitlement, one that medical science had beneficently conferred on all males of shvantz-bearing age—and one that should damn well be covered by an HMO. Men, and the women (or the men) who loved them, were due their Hummers, their surround-sound entertainment centers, and their sustained extremities. And this message beat in time with the pulse of an already overmedicated nation. (Over the course of the decade, prescriptions jumped 50 percent—an astounding increase.)

Many Boomers in the ’90s, meanwhile, still measured themselves by the yardsticks of their youth. Though they had aged in calendar years, many believed they could use newfound compounds to eke some extra mileage out of their battered physiques and psyches. Thus they became assuaged, and in some cases ravaged, by Ambien and Xanax, Lipitor and Crestor, Prozac and Vioxx and OxyContin, while their children scarfed down their own pharmacopeia of Accutane and Adderall and Ritalin.

In the meantime, the FDA, aided by deregulation in the drug sector, began to greenlight more pharmaceuticals more quickly, allowing firms to recoup their hefty development outlays. The Web made it easier, for good or ill, to purchase pills online. Drug companies would tout new tablets and their side effects in magazine ads, appealing directly to patients and taking the family doctor out of the equation. Consumers, according to Jack Hitt in the New York Times Magazine, were being told “to take charge of their own health care; politicians [were] debat[ing] a ‘patient’s bill of rights.’ H.M.O.’s themselves [were] built on the idea that individuals will decide the general direction of their care.” And after years of popping vitamins, supplements, and herbal remedies, health-conscious individuals were increasingly open to alternative therapies.

Taken together, these trends propelled American drug expediency and, to a large degree, compounded the prevalence of drug dependency. Many consumers became predisposed to devaluing behavior modification in favor of treating almost any physical or mental impediment with a tablet. The impulse dovetailed neatly with the sin-again/saved-again paradigm that was trickling down from the pulpit and the presidency.

Viagra, to many, was certainly the sin-again drug. But it was also emblematic, to many observers, of how male power was on the rebound. “Medical professionals and patients,” writes Meika Loe in her book The Rise of Viagra, had begun to view their manhood “in the language of ‘trouble’ and ‘repair’ as they grapple[d] with ‘deficient’ body parts.… They imagine their bodies as machines, and they use Viagra as a tool for fixing their broken masculinity.” Indeed, Viagra coincided with the boy-toy extension boom, a phase in which computer science, athletics, medicine, military R&D, and biotechnology had enhanced the body’s capabilities through ever more inventive anatomical add-ons. Come the 1990s, we had evolved into what naturalist-photographer James Balog at the time termed “Techno Sapiens.” We had joysticks for our computer games, headsets for our telephonic conversations, and ever more sophisticated prosthetics. We had night-vision scopes for the battlefield and law enforcement. We had what came to be known as “wearable technology”: our adventure gear allowed us to trundle up cliffs and down into ice caves; our hazmat suits let us navigate despoiled worlds after we’d made a royal mess of them. In this context, Viagra was just the top-line accessory.

This was not merely about profit or prowess or even sexual health. In the course of a year or two, cultural perceptions about the mechanics of what made a man virile would change irrevocably. A man, made hard virtually, could now perform actually—the word “perform” reflecting both the sex act and the new play-acting that was enveloping much of the culture.

Simon Campbell recalls the party vividly. It remains, he insists, one of “the Eureka events” on his personal Viagra highlight reel.

“It was, to my memory, late afternoon,” Campbell says. The company in September 1997 had just filed Viagra’s application documents to U.S. and European authorities, seeking official approval for consumer use. That week a thousand staffers from Pfizer Central Research listened as Campbell stood at a lectern and called Viagra “a feather in everyone’s cap.” Then a live band took over, flanked by bouquets of helium balloons. Clowns weaved about on unicycles and stilts. Jugglers in bowler hats tossed clubs in front of a poster declaring, “Erectile dysfunction impairs sexual performance.” A balloon sculptor handed out suggestive swords. Pfizer had even hired two impersonators dressed up as the ditzy, druggy Eddy and Patsy from the British sitcom Absolutely Fabulous, then at its apex. “They went through the crowd startling people,” Campbell recalls, “[offering] a string of Viagra jokes [with] double meanings.”

Campbell’s colleagues, though, would quickly dispense with the balloons and the bubbly. This was serious business—a business above all else.

Pfizer Command, in a matter of days, began its surefooted march toward consumers’ medicine cabinets. A price point was set for each pill: ten bucks a bump. A dose scale was devised: 25, 50, and 100 milligrams. A shape was selected: a soft-edged diamond. A color was chosen: Viagra blue, Pantone No. 284U—a deep sky blue in the family of the Pfizer logo’s PMS285. (The powder blue color was meant to denote masculinity.) A manufacturing facility was established: in Ringaskiddy, Ireland, where, over the course of three weeks, batches of pure V (sildenafil citrate) would metamorphose into a white powder. These lots would then be shipped to France, America, and Puerto Rico, where they would be cut with other substances and given their distinctive blue cast.

Meanwhile, the insurance companies were courted. From the start, most agreed to cover their patients’ intake, though many would authorize only six tablets a month. Critics would take umbrage that the male-governed medical and insurance establishments had predictably decided to assume the cost of the little blue pill—but not the birth control pill. Such favoritism, they said, once again revealed the sexist priorities that placed the health concerns of men over those of women.5 Opposition was amplified among certain “family values” constituencies for whom both pills—one encouraging conception, the other contraception—were deemed unsuitable for HMO or insurance coverage. (And never the twain shall be reimbursed.)

Wall Street, for its part, was duly seduced. For two years, results of the ongoing trials had been touted in the science and business press. In 1997, Fortune genuflected, naming Pfizer that year’s most admired pharmaceutical company. The Journal of the American Medical Association sang the drug’s praises, pre-launch. That June, Irwin Goldstein told the less scientific but equally physiocentric journal Playboy, “We’re in the midst of an exciting revolution, a new area of sexual medicine called sexual pharmacology.”6 Talk of a Pfizer wonder drug swept from doctors’ waiting rooms to the trading desks at investment firms, where brokers watched the bulge in the company’s stock price.

Viagra would be introduced first in America. But its success was no sure thing. A dormant side effect might emerge to scuttle it. American consumers, out of shame or any number of aversions, might choose to avoid it in droves. Most critically, the FDA might delay its authorization or insist on more trials for what was being presented as a new class of drug.

It was this very angst—about Washington’s imminent approval—that hovered like a snow squall over midtown Manhattan as Team Viagra convened in the spring of 1998. They had come for a press conference at Pfizer headquarters to announce that the company, at last, was launching its long-awaited tablet. But the timing was anyone’s guess. “We were hanging on the FDA,” Campbell says. “I spent five days in New York waiting for the FDA to come through with its decision. I don’t recall any sightseeing. We were practicing [our presentation for the media], doing science. People were pretty tense.… You’ve invested so much in it, you feel, ‘Is something going to go wrong?! Is someone at a high level at the FDA going to shut it down?’” The medical community—and ED-afflicted couples, quietly shouldering their own burden—looked on at an anxious remove.

On Friday, March 27, 1998, at 10:57 a.m., a fax quietly unfurled at a command center that David Brinkley had set up at Pfizer’s offices. It was the FDA, in D.C., giving Pfizer, in New York, its thumbs-up.

“It happened on my birthday—I was fifty-seven,” remembers Campbell, who that afternoon stared down a phalanx of reporters and presented the drug discovery story. Osterloh, who would soon become the televised face of Viagra, spoke about the nuances of PDE5. He spoke about cyclic GMP. He spoke about the best way to take the pill: an hour before intercourse, supplemented by sexual stimulation to allow the drug to kick in. Concurrently, the FDA was fielding its own press questions, and trotted out its chief of drug evaluation and research, Dr. Janet Woodcock—no misprint, that. “Nothing works for everyone,” she said, “but this will be another choice [for patients], a medication that can be taken conveniently.”

No one, however, was prepared for the deluge.

The next morning, the New York Times’ headline read: “Huge Market Seen [for] Impotence Pill.” The Wall Street Journal heralded “a new medical era.” Time ran a cover story in which writer Bruce Handy wondered, “Could there be a product more tailored to the easy-solution-loving, sexually insecure American psyche than this one?… What else can one say but Vrooom! Cheap gas, strong economy, erection pills—what a country!” (One psychiatrist fretted about all the hype, telling Time, “[Patients] think Viagra is magic, just like they thought the G spot worked like a garage-door opener.”)

In a matter of days, the national hankering for Viagra crossed the threshold into frenzy. Word surfaced that in California, thieves pilfered a stash from a medical office. Patients began demanding to be moved to the head of their urologists’ queues—some out of medical desperation, some merely jonesing for the next, best kink. Certain physicians began to shelve their tee times and schedule Wednesday and Saturday hours to accommodate the overflow. Dr. Stanley Bloom, a New Jersey urologist, told the New York Times that he’d developed writing cramps from filling out scrips. Some doctors began shipping out pills by FedEx or setting up online dispensaries. All told, medical practices wrote two million prescriptions during the drug’s first two months on the market. Websites sprouted up, pushing pills—and starting a racket that became so lucrative that “unsolicited Viagra pitches,” according to California writer R. V. Scheide, would soon comprise one fourth of all email spam.

Press attention very nearly overwhelmed the marketing team. “The phone calls were continuous for at least four months,” according to Mariann Caprino, of Pfizer’s corporate communications office. Brinkley says he hired a clipping service to “scan five thousand periodicals around the world—and websites, [which] were still nascent at the time.” The day after launch, they got fifty clippings. “Three weeks later, we were going through mountains.”

Comedians went on a Viagra jag. How is Viagra like Disneyland? It’s a one-hour wait for a three-minute ride. Heard the one about the Viagra computer virus? It turns your floppy disc into a hard drive. And, perhaps most enduringly, a mock news alert became the stuff of Viagra lore: A truckload of Viagra was stolen today. Police are looking for a gang of hardened criminals.

“It would have been hard to predict how quickly Viagra got into the public discourse,” Brinkley says. “Before approval, we used to wonder, ‘Gee, I wonder if Jay Leno will ever make a joke.’ And then, of course, he ended up telling a Viagra joke every night for weeks.” (Over the next five years, the Wall Street Journal noted, Leno would log 944 V-gags.) One Leno punch line imagined a rejected Viagra slogan: “Church won’t be the only place that Granny shouts, ‘Bingo!’” Newsweek described a “shell-shocked” Pfizer chairman Bill Steere, who contended he would “fall asleep to Leno’s Viagra jokes, wake up to [Don] Imus’s and come home to his wife’s latest.… ‘Nobody used to talk about impotence,’ says Steere. ‘Now [men] come up to me and tell me about their Viagra moments. I can’t believe the things people say.’”

All the while, Osterloh would press on at press conferences, trying to treat the subject with the gravity it deserved. He was probed by questioners such as journalist David Friedman, who asked him if he’d ever tried old blue himself. “Certainly not,” the doctor sniffed. The reserved, bookish Osterloh remembers one mortifying appearance in a London television studio. “They break for news,” he says, “and then suddenly some other guests come in and they start talking about some general TV soaps and the sexual lives of these actors and actresses… and they’re asking me my opinion. And I can’t say anything for a second. And they all looked at me, waiting for my answer to the question, as if I’m from another planet.” (Osterloh today relays a favorite from that first year, courtesy of the British comedian and entertainer Bob Monkhouse: “Quite a good one, actually. He said, ‘It says on the packaging, “Take it about an hour before commencing intercourse.” Good idea. It gives you time to find someone.’”)

By this point the marketing team had settled on two possible approaches for introducing the drug to consumers: advertising that stressed either the performance angle (appealing to men hoping to restore their sexual capacity) or the intimacy angle (appealing to partners hoping to revitalize their relationship). Focus groups were asked to choose between various scripted scenarios: two men in a boat (discussing their exploits of the previous evening) versus, say, a dog waiting outside a closed bedroom door (with a tagline: “Man’s New Best Friend.”) The winning concept, of course, turned out to be the Dancing Couples.

After a time came the performance play. Photographer Michael O’Brien—a portraitist known for his use of warm, suffused lighting and his Norman Rockwell knack for making everyday people look heroic—was signed up to do a series of print ads. O’Brien is a laconic, aw-shucks Memphis native. He remembers the assignment as “celebrations of accomplished and cool males—sort of male clichés, like a man working on a sports car, or a man having an artist’s studio in his backyard—so here’s a very virile, artistic, creative [type]. They’d done tons of market research, so they had it exactly: he’s, like, forty-six-and-a-half to fifty-four-and-two-thirds, and had this much income.

“Being the photographer involved, it’s our job to hire a casting agent,” he remembers. He tried to fill the bill of the creative director of Cline Davis & Mann, Pfizer’s ad agency for the Viagra account. “We looked at hundreds of guys,” he says, looking for “the alpha male. The alpha male is a man who knows who he is. He has an inner security and self-confidence and carries himself that way. He’s not the wimp or ‘the indecisive.’ He’s the male that’s sure. He just has this one little problem. ‘ED,’ they say.”

The ideal model, O’Brien says, “might have a beard and look very powerful. Very present. It was not television—so it didn’t matter how [he] talked. If he looked too fey he wouldn’t be cast. He had to be strong, masculine, not effeminate. Not Alan Alda. More Robert De Niro or Robert Mitchum. But not so much that it’s a caricature.”7

Soon came the endorsement commercials from athletes like Pelé, and baseball’s Rafael Palmeiro (“I take fielding practice, I take batting practice, I take Viagra”), and NASCAR drivers, who would emblazon their cars in Viagra blue.8 Indeed, sports and Viagra would become a man crush made in marketing heaven. Both, to put it plainly, focused on men and their balls. And the big game, Pfizer recognized, was precisely where an advertiser went to attract a mass male audience. The Y-chromosome bonanza associated with professional sports gave the erectile-impaired a cover: I may not be hitting them out of the park, but I’m still on the field.

Subsequent commercials, writes communications professor Jay Baglia in his book The Viagra Ad Venture, were laden with “male signifiers [such as] tools, buildings, flag poles, masts, columns,” along with heavy visual references to “the powder blue color of Viagra.” (By 2004 Pfizer would get much bolder, winking at its own use of euphemism. According to Baglia, in one spot, “featur[ing] the rock anthem ‘We Are the Champions’ by Queen, men burst from their homes on a suburban street… dancing and high-fiving each other [in a neighborhood of] penis-shaped white picket fences.”)

As with any drug, success was tied to the mojo of the sales team. And Pfizer’s might as well have been recruited from Straight-Arrow Central Casting. “Our trainers joked that the sales force was comprised of the ‘Three Ms,’” former Viagra salesman Jamie Reidy would put it, “Military, Minorities, and Mormons.” Reidy would characterize Pfizer’s pharma reps as men and women who were physically attractive, clean-cut or well-coiffed, and “used to taking orders.” They were competitive types with a generally “elevated intensity,” who, once they’d been indoctrinated by their trainers, all “bled Pfizer blue.”

“Pfizer was recruiting extensively among ex-military,” David Brinkley remembers, “because they’re great team players, very disciplined. They’re self-starting.” The hitch was that once they were confronted with the subject of Viagra, many were at a loss. “You’ve got this group of really go-get-’em, very testosterone-ized people in a room, but [impotence was] outside their realm of experience. So we have to give them a lot of context so they can handle the inevitable—hmmm—childishness that comes with talking about sex and sexual function.”

Eleven days after the FDA’s go-ahead, more than a hundred company reps from the urology division hunkered down at Miami’s Doral Golf Resort and Spa “for a thirty-six-hour crash course on Viagra,” Reidy would recount in his book Hard Sell: The Evolution of a Viagra Salesman. Before arriving, they’d been sent reams of reading material covering human sexuality, sexual dysfunction, sociology, prospective competitors, side effects. They made a point of studying the fine print on the so-called package inserts—those thin scrolls that accompany pill boxes and outline various precautions, interactions with other drugs, and when to drop the K-Y Jelly and head for the ER. “We memoriz[ed] success rates and side-effect percentages,” Reidy writes. “We rehearsed sales pitches until we knew them cold. We were ready for war.”

A month later, the company hosted the product’s official launch. Several thousand employees descended on Orlando, including reps from all five of Pfizer’s divisions, each of whom on their sales calls would be required to know the ins and outs of Viagra. They viewed PowerPoints, attended breakout sessions where they practiced real-life sales scenarios, watched training films in which actors would stage embarrassing or tense encounters in the field. “We had to give them training on how to deal with sensitivity, with the topic of sexual function,” says Brinkley, “how to talk naturally in a business setting about penises and vaginas and ejaculatory dysfunction, how to recognize when an inappropriate situation is developing.… We actually had training on potential sexual harassment situations for our reps because a good number were female, and we had a responsibility as an employer to create a working environment for them that isn’t hostile.”

The reps gorged on a buffet meal at the Universal theme park. Viagra goody bags were dispensed. The capstone of the retreat was a presentation that turned into a pep rally. “When we got [to] the auditorium,” Simon Campbell remembers, “there were no seats for us. So Pete Ellis or Ian went down and removed all the ‘reserved’ signs on the seats [and we sat down]. When the people who belonged to those ‘reserved’ signs came and saw us, they said, ‘What are you doing in our seats?’ We said, ‘We discovered Viagra.’ And they said, ‘Have ’em.’”

Ian Osterloh, in his usual role as Viagra’s understated hombre, energized the troops and garnered a standing-O. Then CEO Bill Steere whipped them into a fervor. “The hype at the meeting was incredible and almost evangelic,” Peter Ellis says. “Everything was big and bolder than life. There was a great light show. I remember being somewhat bowled over by the very exuberant American approach as compared to the reserved British, stiff-upper-lip caricature.

“I think the reps got commissions and if they met sales targets they’d get a form of reward such as ‘Go on holiday with the family.’ One guy got onstage and said, ‘Here is the current advance sales—and here is the target.’ And already the sales had exceeded the target. At that, everyone in the room stood on their seats cheering—because they knew that they’d made their sales targets and would be getting their bonuses without having yet left their initial launch meeting! This was hilarious for us. The whole room was erupting around us and we’re feeling very bemused by it all: ‘Good God.’”

But just on the horizon, the thunderheads formed.

“There was an eminent ophthalmologist, Dr. Michael Marmor, going on the radio the next day,” Ellis recalls, “to say that Viagra had the potential to make people go blind. He was the secretary of one of the large ophthalmology societies and there had been a misprint in the approval on the FDA website… which led to this misunderstanding. There was a core group of us who were up most of that night troubleshooting the issue and we missed much of the evening festivities—the whole of the Universal theme park—because we were compiling the real data for this ophthalmologist to reassure him that what he’d seen was wrong.”

And then people started to die. Less than two months after launch, both Pfizer and the FDA revealed the sudden deaths of six men who had recently taken the drug. Since the announcement lacked specifics, it was unknown if any of the patients had also been on nitroglycerin for heart conditions—or if any were elderly (three-quarters of the million-plus prescriptions were made out to older men, some of them cardio patients, who are not unknown to have suffered heart attacks after strenuous exertion). Pfizer began getting hit with wrongful-death litigation; by fourteen months out, more than five hundred had died.

While independent monitors determined that none of the volunteers in Pfizer’s clinical trials had ever died due to “a heart attack, stroke, or life-threatening arrhythmia within six months of taking the drug,” these new fatalities were cause for alarm. First, blindness; now myocardial infarction. And even though the Viagra-induced ER visit would in time become a comedic staple (Jack Nicholson’s gallivanting character in the 2003 film Something’s Gotta Give, for instance, would twice be rushed to the hospital after riding the V-Train), in those first few months there was considerable concern among physicians and patients and their partners.

Not that this deterred Joe Rep. Pfizer’s sales force kept meeting and exceeding its targets. “Nobody took Viagra and then, boom, had a heart attack,” Reidy would write. “Rather, they took Viagra, had sex, and then had a heart attack. The activity killed them, not the drug.… ‘ Of course they’re having heart attacks and dying,’ an exasperated urologist barked at me.… ‘If you wouldn’t let a guy carry a suitcase up a flight of stairs, then he shouldn’t be fucking!’” Pfizer, of course, reiterated its warnings. The company told health care providers, ER teams, and paramedics that the blue meanie shouldn’t be doled out to the out-of-shape—and that a nitrate-Viagra combo was verboten.

In the face of all these stories, recreational use proliferated. Time was reporting on retirees planning Viagra bashes in the Poconos. Penthouse wrote about the comings and goings of the man who ran Nevada’s Moonlite Bunny Ranch—on a junket to Amsterdam and armed with some baby blue. (“I ended up partying with six different girls that night,” he decreed.) Club kids began popping pills casually, David Friedman would note, “often [taking them] in conjunction with Ecstasy, a party drug that enhances sexual desire but can inhibit sexual performance.” (The resulting cocktail was dubbed Sextasy.) A popular Viagra-plus-methamphetamine mix would facilitate sex marathons that became notoriously debauched, according to the Boston Globe’s Diedtra Henderson. She quoted a source who insisted, “We’re talking days. Days, not hours… no eating, no sleeping.” Discussing the public-health consequences of such activities, Meika Loe would write, “Gay publications such as the Advocate [warned] about the potentially lethal combination of Viagra with crystal meth, poppers, and Ecstasy, as well as the potential for ‘risky sex’ and HIV transmission with such drugs.”

It would take several years before a credible statistical correlation would be drawn between STD transmission and recreational Viagra use. And there would also be a pattern of “senior scare” stories on local and entertainment-news programs. These described wives who were exhausted by husbands with new skin in the game; by “Viagra studs” who had fled their longtime partners to strike out on their own; by voracious Viagra addicts—male and female alike—who went on binges; by elderly husbands who had infected spouses with STDs after having used the drug while visiting prostitutes; and by predictions of a bumper crop of babies sired by aging “Viagra dads.” (This turned out to be a demographic dud. The National Center for Health Statistics would show, ten years later, that “fatherhood rates among older men,” according to Hilary Stout in the New York Times, “[had] not risen since Viagra came on the market, [remaining] exactly where they were in the early ’80s.”)

Almost from the start there was a conservative backlash. Pfizer, no matter how careful it had been in trying to divine the public’s reaction to the drug, could not have foreseen the political throw-weight it possessed as a totem of the culture war. With reports of an illicit White House affair dominating the Web and the late-’90s newswires—concurrent with ED bulletins commanding the science, business, and lifestyle headlines—certain elements began to attack Viagra as a lax-values drug. Viewed through this lens, Viagra was a pharmacological outlier with antecedents in the ’60s (the pill, which had propelled contraception) and the ’70s and ’80s (the age of party drugs, which had further diluted the nation’s moral fiber). Soon the whispers crescendoed: the drug was being downed by porn stars like hors d’oeuvres. The drug was being sold for recreation, not procreation.

“When it became like a national punch line,” Brinkley recollects, “a lot of conservative groups would say, ‘This is trivializing sexual relations. This is typical of American culture where sex is everywhere.’” And when media pieces appeared offering conjectures that gay men were disproportionate users of Viagra, Brinkley took offense. “[Why] gay men got singled out as a demographic other than their titillating value for the mainstream press, I don’t know—but there were a series of articles that ran. Then there was even some speculation kind of on the fringe, from conservatives, that Viagra was going to increase AIDS in America—that giving gay men erections and then enabling them to have unsafe sex, that somehow there was going to be an explosion in HIV.

“When I’d read these articles—those became some of the most upsetting to me,” he confides—“I, maybe in the back of my mind, wondered, ‘Well, if somebody found out I was gay and they tried to connect the dots, that they would think it’s again part of [some] Velvet Mafia.’” But it would be preposterous, he insists, to draw any conclusions about such an agenda—whether in pharmaceuticals, advertising, or Hollywood. “Really? Have you ever seen five gay men try to figure out where to go to dinner? And you think we’re trying to take over the country? I mean, come on.”

The rumors of blindness. The death knell. The recreational use and abuse. The cultural and religious resistance. None of it seemed to make much of a dent. Two years on, Viagra was being prescribed at a pace of seven pills a second—with a supply being dispensed, as it happens, to one out of every twenty-five adults in Palm Beach County, Florida. In that same time frame, 93 percent of Americans would become familiar with the Viagra moniker (and its purpose)—a brand-name recognition that rivaled that of Coca-Cola, which had been around since 1886.

Meanwhile, women were experimenting too. Research indicated that genital blood flow was enhanced when a member of either sex partook. For Salon.com, Susie Bright popped some blue and wrote about her multiple climaxes, including one that came on “like the most delicate, melting chocolate cream egg cracking inside.” On Sex and the City, Samantha—Kim Cattrall’s character—did the same. (She would later admit to taking some in real life, as reported in the British press: “All that business about multiple orgasms? It’s true. I’m not just having two or three. It’s four or five.”)

From the boudoir to the boardroom, the storm surge lifted all boats, including Pfizer stock. Company shares on the day prior to the New York press conference had stood at an already lofty $95 each. By the end of a year, the stock had risen nearly 40 percent, then split—with Viagra’s gross revenues eclipsing a billion dollars. By the end of the decade, according to Simon Campbell, “more than 150 million tablets [had] been dispensed worldwide [in] over 100 countries.”

I am on a flight to New Orleans. I am seated next to a man who tells me he’s on the rebound from hip replacement surgery. An athletic African American, he turns out to be fifty-one, married for twenty years, and the father of a teenage daughter. All at once, I experience something I never would have encountered in the 1990s—a time when men typically didn’t talk openly to strangers about their setbacks in the sack.

After exchanging pleasantries, the passenger introduces himself as D. (name withheld), from Dayton, Ohio. He mentions his job in the pharmaceutical industry and I discuss my visit to Pfizer in search of the story of Viagra. And in a sudden, unsolicited outpouring, he cannot stop gushing about the wonders of the drug.

Six years before, D. says, he began taking high blood pressure medication for what he describes as “a condition affecting African Americans that is also caused by diet and other factors. It had an immediate effect on ‘quality of performance.’ You could get the job done, but it was a job.” Despite this impediment, he says, he continued with his medication. “If I didn’t take it, I was going to die.”

As for the unfortunate side effect, he reasoned, “Maybe this was karma. I thought I had the game nailed in my twenties because I had total control of the outcomes of my physical pursuits. The only thing that made [my new reality] cool was: when I was younger I had had my share. And when it came to a screeching halt, I thought, ‘Everybody gets theirs and if you overdo it, you pay the price later on.’”

Karma—with a caveat. On one of his monthly visits to his psychiatrist, D. says, he mentioned his diminished erectile function, and without hesitation she wrote out a prescription. “I [had] thought that having a regular sex life was out the window,” he claims, “and I’d pretty much come to peace with it. But [the drug] was like a gift. With the Viagra I had such a strong erection that it almost scared me.… This Viagra thing has added joy to my day-to-day.”

Two of his friends—both of whom have survived prostate cancer surgery—are also users. “They were highly stressed with this bad boy,” he says, but now “it made them men. It had restored a sense of self-esteem.” He then takes the long view. “These guys [at Pfizer] that pulled this together—I don’t think they knew the impact it would have on people’s mind-set. This is a game-changer.”

The game would never be the same. After all the lab-tested molecules; the internal memos; the rooms with men hooked up to RigiScans; the Nobel Prize in Medicine (for the men who deduced the secret of nitric oxide), Pfizer’s scientists had understood the significance of the unambiguous attraction of human bodies and, in turn, of minds and spirits. They had set their sights on connecting couples, literally, through chemistry. And they had succeeded beyond their most implausible fancies.

What got lost sometimes in the consumer’s mind and in the culture’s miasma was the deeper purpose of the drug. All the wood in the world wouldn’t make up for the inner passion and emotional capacity required of the user and his partner.

In the end, Viagra, as a medical watershed, was profound and far-reaching. In the early 1990s, among a few men in Wales and Bristol, a nameless compound’s minor side effect had been identified. That compound was then tapped, harnessed, and dispensed across the globe. Within a few short years, it would help millions interact, and deeply, again and again. And all because of the unique properties of a peculiar molecule.

That molecule’s story came down, as so many tales do, to the wisdom of promoting human relationships. It came down, finally, to recognizing those persistent, primal connections that have forever ruled creation.