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The Importance of Viagra: Concurrence vs. Dissension
In the age of medical progress, scientific knowledge and medical answers are generally unquestioned as the best, most efficient, most legitimate solutions. However, the history of science, medicine, and technology is also a history of attempting to solve social problems and control populations. -Meika Loe, author of The Rise of Viagra: How the Little Blue Pill Changed Sex in America In the late 1990s, Viagra emerged as a pop culture phenomenon due to the massive public response and plethora of international attention given to the drug by all modes of the media. It seemed that every publication, radio and television station opted to add the drug to its assembly of newsworthy items, albeit generally focusing on a specific aspect relating to its efficacy, development, safety, or social impact. Viewed optimistically, the barrage of media attention also served to legitimize sexual dysfunction, bringing the topic “out of the closet” as never before (Rosen, 1998). Hence, Viagra, considered such a popular ‘news-worthy’ event worldwide, as well as a completely new development in the field of erectile dysfunction treatments due to its reliability, discreet administration and minimal side effects (Goldstein et al., 1998), would undoubtedly capture the attention of even the most prestigious medical journals. However, the attention bestowed on the drug by these publications was lukewarm at best. I propose that a controversy arose in the international research community largely ‘under the radar’ at the time of Viagra’s launch, as well as in the coming years. Clinical medicine and nursing titles comprise the majority of a typical hospital library’s journal list and are of critical importance to large academic medical and research centers. Selected English language core clinical journals are found in the Abridged Index Medicus, which was published by the National Library of Medicine (NLM) from 1970 - 1997. Although the NLM no longer produces the Abridged Index Medicus as a print publication, the value of the titles as a core list of “selected titles of biomedical journal literature of immediate interest to the practicing physician” is still recognized (United States National Library of Medicine, 2005). These titles continue to be searchable on NLM’s Medline database as a search subset limit called ‘core clinical journals’. Two of the most prestigious core clinical journals are titled The Lancet (published in England), and the Journal of the American Medical Association (JAMA). If the complete archives of The Lancet are examined, a surprising find transpires. Of the 25 articles mentioning sildenafil in the title, abstract or keywords, only 7 are journal articles. The others are news events, commentaries, editorials and letters. Of these 7 journal articles, only 3 address sildenafil as a treatment for erectile dysfunction, including one focusing solely on its retinal side-effects. The remaining 4 journal articles report new, non-ED related, clinical uses for sildenafil. These include its use as a treatment for lung fibrosis and pulmonary hypertension as well as its effect on local inflammation reactions experienced by Crohn’s disease patients. From the examination of this journal, it becomes evident that sildenafil is seen as an interesting compound, but not necessarily as a compound of interest solely for the treatment of erectile dysfunction. An examination of the archives of JAMA nets similar findings. Of the 21 articles mentioning sildenafil in the title, abstract or keywords, only 7 are journal articles. All 7 of these journal articles, however, address sildenafil as a treatment for erectile dysfunction. If the term ‘Viagra’ is searched in these archives, although more items such as news reports and commentaries are found, none of the search results are journal articles. The fact that these core clinical journals did not publish many articles on sildenafil may suggest that the treatment of erectile dysfunction with Viagra was not, and is not seen as a very legitimate medical concern in the mainstream medical community. Debates in the letters, editorials, and commentaries about whether ED is a serious problem and one that the medical profession should be paying attention to, highlight this stance.
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