Viagra: "The Next Generation"

Pfizer was the first to bring us ED (erectile dysfunction) and now two companies—one large (Johnson and Johnson) and one small (Sciele Pharma)—are daring to boldly go where no MAN has gone before: to conquer PE aka premature ejaculation!

According to a brilliantly-crafted story by Natasha Singer published in this Sunday’s New York Times business section, JnJ developed a pill called Priligy which is intended for men who ejaculate before intercourse or within a few seconds after beginning. Priligy which is intended to help to prolong latency before orgasm is approved and sold in nine countries but hasn’t been approved for sale in the US. On the other hand (so to speak), little known, Atlanta, GA-based Sciele Pharma is planning to seek regulatory approval for a prescription aerosol-based product that is sprayed on the skin (in this case the penis) to prolong latency and forestall ejaculation. While the true incidence of PE is uncertain, the manufacturers of these medications want men (and women) to believe that the condition is more pervasive and prevalent than reported. 

Interestingly, the worldwide sales of Pfizer’s Viagra were approximately $1.93 billion last year. As previously noted on BioJobBlog, Viagra celebrated its 10th anniversary of marketing approval last March. If you do the math, almost $20 billion dollars worth of Viagra prescriptions were written over the past decade. This suggests that many millions of men must suffer from ED worldwide. However, for those of you who may not know, Viagra also works quite well for healthy, sexually active males who don’t suffer from ED. It is generally acknowledged that it is this segment of the male population that is responsible for the annual blockbuster sales of Viagra and related medications. Also, it is important to note that prior to the introduction of Viagra, ED wasn’t a recognized clinical indication (it was known as impotence) and there were very effective treatments for it. And while ED is a legitimate quality-of-life issue, it occurs in only a small percentage of sexually active males; mostly in older men with hypertension, cardiovascular conditions or those who have had their prostates removed.

Viagra, like Botox, Latisse and others, is classified as a so-called “lifestyle” drugs. Generally speaking, lifestyle drugs are developed to improve the quality of life of patients not treat potentially life threatening diseases or conditions. In her article, Ms. Singer takes the pharmaceutical industry to task about the development of  blockbuster lifestyle drugs.

“But creating a blockbuster quality-of-life drug like Viagra involves more than just being innovative or being first. Sometimes it requires a drug maker to create and market a whole new category of disease.

The template goes something like this: Start with a legitimate quality-of-life issue — like fitful sleep or shyness — that does not yet have its own prescription medication and is debilitating to a few people a lot of the time. Next, position the quality-of-life issue as a medical condition with symptoms so common it covers vast numbers of people who had previously not identified themselves as having a health problem, or who thought they were just experiencing an occasional and normal annoyance.

Articles in medical journals with high estimates on the prevalence of the issue help convince doctors and journalists of its scope. F.D.A. approval of the new drug legitimizes the condition as a problem with a medical solution.

While there is no doubt that some men are distressed about their inability to control their orgasms, there is little concrete evidence to suggest that there is an epidemic of premature ejaculation”

Although I have never used Viagra, I have a few “older male friends” who swear by it! And, while I have no doubt that Viagra and the new medications being developed to treat PE may benefit a few men, is it appropriate to elevate premature ejaculation to a bona fide clinical indication and spend billions to develop and market treatments for it? Don’t get me wrong; I am not trying to minimize the emotional distress and discomfort associated with PE. But, the last time I checked, PE didn’t make the top ten lists of the world’s most devastating and debilitating clinical indications or unmet medical needs!

Until next time...

Good Luck and Good Job Hunting!!!!

 

What Does Unmet Medical Need Really Mean in "Pharma Speak"?

Every major pharmaceutical company on the planet declares that it “invests billions of dollars into R &D to develop novel medicines to address unmet medical needs”. Further, pharmaceutical company advocates and lobbyists frequently justify the high costs of medicines by suggesting that they are necessary because companies must reinvest a portion of their profits into R & D to discover new drugs. After receiving several comments posted to BioJobBlog informing me that high drug prices are necessary in order for pharma companies to continue to meet unmet medical needs, I decided to delve a little deeper into what “addressing unmet medical needs” really means in the pharmaceutical industry.

My personal favorite that seems to fit pharma’s interpretation of “addressing unmet medical needs” is the development of no fewer than 3 medications (Viagra®, Levitra® and Cialis®, with several more in clinical trials) to treat erectile dysfunction (ED). For those of you who don’t know, all three drugs have almost identical mechanisms of action. Who knew that so many men had this serious, potentially life-threatening medical condition? Don’t get me wrong–there are men that must take these drugs to …well…rise to the occasion. That said, pharmaceutical marketers realized early on, that this class of drugs could yield billions of dollars–not necessarily as ED treatments (the number of men who actually suffer from ED is relatively small) – but as recreational drugs to enhance male sexual performance. The booming sales figures for these drugs indicate that the pharmaceutical marketers were absolutely spot on in their thinking. Thanks to these pioneering medical marketers men all over the world no longer have to fret about dying or succumbing to the perils of ED.



Another class of medications that warrants mention is the statins. This class of drugs is routinely used to lower blood cholesterol levels to reduce the risk of hypertension, heart attack and stroke. At present, there are 9 statins on the market (with almost identical mechanisms of action) and 3 combination products either marketed or being developed. Everyone knows (or should know by now) that high cholesterol is not good for your health. That said, is the unmet medical need in the cholesterol control market so large that it requires 12 different medications to deal with it? Or maybe (and I am just guessing here) that every company that developed a “new” statin in recent years did so to grab a piece of the $10 billion per year Lipitor® market that Pfizer created?

Finally, Lilly and Daiichi Sankyo are developing a new antiplatelet drug called prasugrel to treat thrombosis and related clotting disorders. Business analysts are extremely high on prasugrel and estimate that if approved, the drug could yield over $1.2 billion per year in sales. Prasugrel is touted to be more potent than Plavix®, the leading anti-clotting drug marketed by Sanofi-Aventis and Bristol-Myers Squibb. Not surprisingly, both clopidogrel (Plavix®) and prasugrel work in almost exactly the same way to prevent clotting (as their generic names indicate). However, in early clinical studies prasugrel caused 4 times as much uncontrolled bleeding than Plavix®. So, why are Lilly and Daiichi Sankyo willing to continue to spend billions of dollars to develop another clopidogrel-like molecule? Unfortunately, the answer is relatively simple– Plavix® will lose patent protection in 2011 and Lilly/ Daiichi Sankyo are betting that they can snatch a share of $6.0 billion dollar Plavix® market that will be eroded by generic competition. Why develop a new medication with a different, untested mechanism of action when a market for similar products has already been created for you by your competitors?

Paradoxically, pharmaceutical companies used to the most innovative companies in the world. However, in the past 20 years or so, pharmaceutical companies have jettisoned innovation in favor of a less risky “me too” approach to business. Simply put, it is less risky to develop drugs that work like previously approved drugs (and already have large established markets) than it is to invest larges sums of money to develop new unproven drugs that may actually address unmet medical needs. It is a good thing that the biotechnology industry came along when it did……!

Until next time…

Good Luck and Good Job Hunting!!!!!!!!!!!!