Skip to content

Piloting pharmacy prescriptions of Viagra – whilst the media foams at the mouth

February 12th, 2007

Dr Petra

You’ve probably already seen all the hundreds of headlines telling us that Viagra is going to be available on the high street without prescription. Well it is that time of year when commercial companies do their best to cash in on Valentine’s Day and get loads of coverage.

Boots the pharmacy and Pfizer have scored a massive PR prize today, knocking out of the headlines all those other sex toy manufacturers, charities and pharmaceutical companies who were seeking a Valentine’s day tie-in.

And it’s come completely out of left-field taking sex educators, doctors, relationship counsellors and psychosexual therapists completely by surprise.

The pharmacy is running a pilot study of three branches of Boots in Manchester. The drug will be available to men after a check up from a pharmacist (involving a blood pressure, cholesterol and glucose level test). If the pharmacist finds they fit the criteria for the drug they’ll be able to purchase four tablets for £50. After this, if men want to continue having the drug they can pay £37.50 to see a private doc and have a full medical exam before being allowed any more tablets. The pilot is open to men aged 30-65 and boots claim only 10% of the 3 million men in the UK who they think have erectile dysfunction are currently being treated.

But let’s look at this more closely.

Press coverage has been extensive, over excited and completely non-critical of the whole event, for the most part suggesting that as of Valentine’s day this week if you want to get Viagra without seeing your GP then you should head straight to Boots.

This is incorrect since only three pharmacies are participating in this pilot and the drug will only continue to be sold over the counter if the pilot generates enough interest from men (once the media brouhaha has died down) and also if the men purchasing the drug can also be persuaded to buy other products from the pharmacy. After all Boots are a business and they want your cash, if men just come in and buy a one-off supply of Viagra and don’t buy anything else from the store and don’t come back again, then it’s likely the pharmacy won’t see it in their interest to keep the scheme going. Unless, of course, Pfizer pay them to do so.

Currently if a man has problems with getting or keeping an erection he can see his GP who will look over his medical history, give him a full medical exam, and then discuss with him his relationship status to see whether he truly has erectile dysfunction (or just has the occasional problem getting wood) and whether the problem would benefit from other forms of help – such as relationship counselling, sex education or psychosexual therapy for him or his partner. The GP will also be able to help the many men in a state of distress find erectile dysfunction drugs don’t work for them.

The Boots advisors appear to be trained to do a basic medical history but won’t have anything other than the customer’s story to go on – they won’t have access to medical notes. It is unclear from the press coverage if they will refer men whose problems are more likely based on psychological or relationship difficulties to other sources of help (as they should do) or will advise them to take the meds instead. Evidence from where doctors have been trained solely by pharmaceutical reps show they will only prescribe the drug they’ve been trained about (usually because incentives are offered if they do so). This has been widely criticised in the US and UK but there’s a risk it could happen in this case since a. the pharmacy wants to make money and b. they’ve only got one drug to offer.

After you’ve seen the Boots advisor if you want to continue taking the drug then you’ll have to pay extra to see a doc who’ll give you a full medical exam. Viagra is not a benign drug without serious side effects and really the full medical exam should come first. Boots and Pfizer seem to have got this completely about face. Surely it would be better to pilot someone getting a first prescription from the doc and after this to be able to continue to get the drug (if needed) direct from the pharmacist? That would allow the GP to ensure the person really needed the meds, to monitor their health, refer to other treatment if needed and hand over to the pharmacy when satisfied the man was okay. If the pilot was really robust it should be testing both approaches, why isn’t it?

There’s an interesting approach in the men the pilot is open to – age 30-65. Most evidence suggests that with the exception of young men with MS, diabetes or spinal cord injury the main age group of men with a clinical need for Viagra are in their late sixties and over. So why is such a young group who’re very unlikely to need the drug being targeted by the pilot? Particularly if such men do have erectile problems they should be definitely seeing their GP, as they’ll probably have other serious health conditions. A growing number of doctors have claimed this is a wider symptom of Pfizer’s marketing – aiming the drug at an ever-younger audience. Could it be this is happening with this pilot – and might that explain the need to see the private doc who’ll probably continue to supply you with the drug when your own GP may not?

Boots also claim that only 10% of the estimated 3 million men in the UK affected with erectile dysfunction are being treated. I’d like to know whether Boots worked that data out themselves or were told to say it by Pfizer who are known for increasing levels of sexual dissatisfaction, rebranding them as sexual dysfunction to make people feel that erectile dysfunction is a bigger medical crisis than it actually is. That’s not to say that men don’t have ED or don’t suffer horribly when they do. It’s just to say that Pfizer and other companies making sex drugs are known to distort figures to increase the need to medicate men. If Boots had looked at the data they would know that the number of men in the UK affected with erectile problems (particularly those aged 30-65) is far fewer than 3 million.

Boots’ involvement in previous pilots

It’s interesting that Boots have decided to pilot this particular drug rather than trial other ones. They have participated in a chlamydia testing pilot – which we’re still awaiting results on. Anecdotal feedback from that pilot suggested Boots weren’t massively keen on it since it didn’t give them the chance to sell much to customers. There were plans a while ago that Boots would advise on and sell sex toys but this was dropped because of a lot of media fuss and criticism. In the past Boots have refused to allow women the chance to get small amounts of antibiotics to treat cystitis from pharmacists even though the women know this works for them. The pharmacy has also steadfastly refused to stock speculums for women to carry out gynaecological self-exams (on the grounds of hygiene) and won’t let you get hormonal contraception from them without a prescription from your doc (although this may change soon). So clearly Boots have had opportunities to stock a number of sex-related products but they’re very selective on which ones they choose to pilot and promote. As a business they clearly go for the products that are not overly controversial but do bring in the most business.

Why is this happening now?

Pfizer, makers of Viagra had a boom of sales of the drug worth billions when it launched. Since then other drugs like Cialis or Levitra have come on the market – both of which act more quickly and last longer than Viagra. Pfizer are noticing a dramatic market share loss on the drug and are keen to get it back. They tried to get permissions to sell the drug over the counter in US pharmacies recently but this was refused. So even though the US is in many ways far more lax in its drug availability than the UK they still said no to selling the drug via pharmacies. Why then, has it been given the okay for a trial here?

Questions journalists and the public should ask about this pilot

- How much did Pfizer pay Boots to run the pilot?
- How much is the pilot worth to both Boots and Pfizer in terms of free advertising generated by the extensive media coverage?
- If the pilot doesn’t suggest selling the drug will be worth much to Boots will Pfizer continue to pay them to ensure the drug goes on wider sale across the UK?
- Who will be evaluating the pilot? Will it be an independent team (as is usually required) or will Pfizer be doing it?
- Why did Boots team up with just one manufacturer of erectile dysfunction drugs and not the three manufacturers who make these medications?
- Did Boots sign an exclusivity deal with Pfizer – and if so will that effect the training staff are given?
- What will Boots staff advise men who seem to have additional health problems causing their erectile problems; will they send them to their GP or prescribe the drug?
- Will customers be encouraged to come back and pay to see a Boots/Pfizer doctor or advised to see their GP if needed?
- Why is the pilot targeting men in such a young age group?
- Why have Boots apparently not understood the epidemiological data on prevalence of sexual functioning?
- What impact might this pilot have on the way men’s sexual functioning is perceived?
- With the advent of the new pharmacy contract is this pilot a means of ensuring a good income for pharmacists that other medications probably wouldn’t attract?
- Who will the advisors in the pharmacies be? Will they be existing Boots staff or people supplied by Pfizer?
Health providers sometimes find it difficult to talk to patients about sex, what support will be available for Boots staff to ensure they are not embarrassed by this pilot?
- In other schemes where pharmacies have been involved in sexual health promotion key staff are given independent training alongside doctors and nurses – is that the case here?
- Will other pharmacy chains now decide to link up with other erectile dysfunction drug manufacturers and what impact will this have on men’s sexual functioning.
- Will this aggressive approach from Pfizer lead to wider competition and sex drug wars between pharmaceutical companies – and what effect will this have on how we see our sex lives?
- What checks are in place to prevent the misuse of the drug (for example men giving it to a female partner or selling the drug on).
- What evidence (aside from a Pfizer rep) told Boots this was a good scheme to pilot – as opposed to piloting pharmacy prescribed medications for other health problems?
- Will other medications that perhaps do not offer the same opportunity for profits be similarly piloted?
- Did Boots/Pfizer consult with other GPs, psychosexual therapists, counsellors and sex educators before deciding on this pilot? If so, what advice were they given?
- The US has banned the availability of erectile dysfunction drugs via pharmacies – why then, is it being tested in the UK?
- It’s well known that erectile dysfunction drug manufacturers deliberately target the media over Valentine’s but what do Boots/Pfizer feel about cutting out media coverage for those offering charitable or safer sex campaigns at this time?

What we’re really seeing is not a pilot of making erectile dysfunction drugs more available to the public, we’re seeing Pfizer get a great chance at selling drug samples direct to the public.

If I were a journalist I would get a number of guys to go into Boots under cover and report back on the advice they were given. That way we’d have an idea about the way this scheme is really being run – and for whose benefit. It’s being sold to us via the media as something romantic or sexy and a little bit fun for Valentine’s Day. But it’s really the best example ever of two commercial companies about to make a lot of money whilst the patient loses out.

Comments are closed.