Get up, stand up
By Perttu Kauppinen
Every day ten thousand Finnish men swallow a pill to induce erection. Medical advertising has turned men into machines that must always function. Consequently, Viagra, Cialis, and Levitra are taken by many men who do not actually suffer from erectile dysfunction, and who merely want to make sure that they are ready for action any time and all the time.
Jaska, a man of less than 30 years of age from Eastern Finland has taken impotence drugs for over one and a half years. Not because he suffers from, or admits to suffering from impotence, but because the drugs make him feel more masculine.
"For example Cialis is just amazing. Girls like it when a man gets tired before his penis does. You get the reputation of a stud", says Jaska.
"The best part is, however, is that there is no more uncertainty while drunk. Even if you cannot stand up straight yourself, at least a part of you can."
Cialis, the drug Jaska mentioned, is an impotence cure, whose effects are said to last for as long as 36 hours. It arrived the market a few years ago. Drug manufacturer Eli Lilly is trying to capture some of the market share of Pfizer's Viagra, the aspirin of erection enhancers. The third drug competing for Finnish men's erections is Bayer's Levitra.
"Performance enhancers are already sort of a trend among my circle of friends. I do not know anyone who has not at least tried some sort of drug", Jaska says.
Jaska, like his friends, is a university student. He works out at the gym, and goes to bars in search for women. In other words, they are ordinary Finnish men.
Viagra revolutionised the world of impotence treatment with its ease of use as a pill. Erectile dysfunction had previously been treated with complicated injections.
Viagra came onto the market in the mid-1990's. The manufacturer Pfizer stressed that the pills were meant to be used for treating impotence, not for enhancing the performance of healthy men.
After Viagra's competitors entered the market, the evil I-word has no longer been used.
Pfizer's advertisements claim that the drugs help achieve "erectile certainty". Bayer and Eli Lilly speak of "erectile dysfunction".
The companies' web pages contain virility questionnaires. The common factor for the tests is that according to the results, even an occasional failure to achieve erection is a reason to go seek a prescription.
Potency medication has become an everyday thing – just like taking a daily dose of aspirin to achieve the certainty of not having a headache.
"The advertisements create image of sexuality, where a man is a machine, whose cogs and wheels must always turn and function. Everyone has to eat pills in order to be certain", says Riitta Ahonen, professor of pharmacology of the University of Kuopio.
Jaska says that he started taking the pills about a year and a half ago, before the surge in advertising. His friend told him about the power of the pills.
"The advertisements were probably not designed for men like me. Or at least they do not use a guy stumbling out of a bar at four in the morning, for example", Jaska says.
The number of pill-popping men has increased rapidly along with the increase in advertising. About 2.2 million pills were bought in Finland last year to ensure erection. About ten thousand men pop a pill every day.
Finns already spent about EUR 29 million on impotence cures last year. The figure has risen quickly: in 2000 the Finns' erectile security was worth slightly under 14 million.
Despite the great popularity, pharmaceutical manufacturers are looking forward to even better times. They claim that caring for Finnish penises has only reached a good start. Manufacturers claim that as many as 300,000 - 500,000 Finns have problems with their erections, but so far only about 75,000 of them have had the courage to seek help.
The figure should be approached with some caution, since no unbiased studies have been made on the frequency of impotence. And none are likely to be made, estimates, Timo Klaukka research professor for the Social Insurance Institution (KELA).
"The studies that the pharmaceutical manufacturers use have been made with profit in mind. Or then the marketing section has moved the decimal point. The bigger the number of impotence sufferers, the better it is for the industry", says Klaukka.
The number of people suffering from severe impotence problems is known, since they receive compensation from KELA for their medication. Only about two thousand men receive this kind of compensation. However, this requires a serious illness, such as long-term diabetes, or some other kind of neurological injury.
"Not all sufferers seek compensation, since they are ready to pay for their medication. And a larger amount of men have varying difficulties. They are occasionally potent, but not always", Klaukka ponders.
The reason for marketing which exaggerates erectile difficulties is the law that forbids advertising prescription drugs to consumers. Diseases, on the other hand, may be advertised.
This so-called illness-based marketing means that the goal of the advertisements is not to increase the sale of your own drugs, but to spread information about an illness. Basically this means that it is legal to use advertising to strike fear of impotence in the populace, as long as you also mention the competing firms.
The advertisements are monitored by a special branch of the National Agency for Medicines and Pharma Industry Finland. And of course competing drug manufacturers, who are eager to pounce on infringements committed by their competitors.
"Sometimes it is difficult to say what constitutes marketing a drug and what does not. The message of perfectly legal advertisements can be distorted in the media and inside people's heads. There is nothing we can do about that, whether we wanted to or not", states senior chemist Tiina Kostiainen for the National Agency for Medicines.
Drugs can be advertised to doctors and the press, on the other hand. This is exactly what manufacturers have done.
The late-edition tabloid daily Ilta-Sanomat has been especially active in promoting the importance of erectile predictability, having published a dozen or so articles dealing with potency problems during the last six months.
The choice of subject has been so blatant that the paper has been called Impotenssi-Sanomat by the advertising industry's magazine Markkinointi & Mainonta.
The men's section commands men to rise up, and the women's section tells wives to take their men to see a doctor, since achieving a certain erection is a woman's goal as well. Women's magazines tell the same tale, emphasising that women have a right to good sex.
For example, the magazine Madame calls the 49-year-old American actress Jerry Hall the "priestess of potency". Hall, who has been hired by drug manufacturer Bayer to be their Levitra mascot, explains how badgering your partner to get a prescription makes your relationship flourish.
"Drug companies have paid women to demand better sex, more frequent intercourse, and firmer phalluses. What woman would wish to ride a limping steed? Men are supposed to be erection machines and semen cannons", criticises Dr. Markku Myllykangas, Docent of Health Sociology at the University of Kuopio.
The problem for pharmaceutical companies is that newspaper articles that spread fear of impotence improve the sale of all impotence cures, and not that of a specific brand. This is why they must also bribe doctors, so that they know which pills to prescribe when a patient asks for "the woodrow medicine".
"This has created tremendous pressure for doctors. Their patients are pressuring them. They are confronted by consumers that demand a specific drug, even though they are in perfect health", says Professor Riitta Ahonen.
It is entirely up to the doctor from then on. Some tell their patients that they do not need medication even if they cannot always achieve an erection when they want to. Some just write the prescriptions.
"Doctors were once told during pharmacy lectures, that the easiest way to get rid of a patient is to write a prescription. And that is the way it often goes nowadays as well", Ahonen explains.
Janne Lepola, a doctor specialised in treating erectile dysfunction, does not believe that unnecessary impotence drugs are being prescribed. He believes that the patients' insecurity may be so great that it is worth writing the prescription, even if there is no physical ailment.
"These drugs are bloody excellent. Many have had trouble with coitus once, and they have wanted make sure everything works the next time. They take a pill and everything works just fine, and they do not need to take one again. These are not recommended for prolonged use", Lepola says.
Myllykangas disagrees. He believes that disease-based marketing has taken treatment in the wrong direction.
Myllykangas sees performance enhancers are so-called lifestyle drugs. People take them to treat symptoms that could be treated by changing one's habits, or symptoms that hover somewhere between actual medical conditions and an ordinary, bothersome nuisance.
"If a man has temporary problems, it should first be established what the problem actually is, and prescribe medication only after this", Myllykangas says.
He does not think impotence medication is bad: it brings relief to many prostate patients, diabetics, and sufferers of physical trauma.
"But according to studies, the youngest users of performance enhancers are 18-year-olds, who certainly have no such problems", he says.
When Jaska had a girlfriend, he did not use medication.
"Sex in a relationship is so routine. I did not feel like I got any more enjoyment out of medication.", Jaska says.
Using drugs during one-night stands and when having sex with someone other than one's own girlfriend is reasonable according to Jaska, because he receives compliments from his partners. Although he is quick to point out that this would also occur without the drugs.
Performance enhancers and their marketing may increase the pressure for young men to perform. According to the Family Federation's Men's Moment coordinator Samuli Koiso-Kanttila, young people believe too often that a woman's sexual gratification is the partner's sole responsibility.
"Sex is not something that can be measured, but now the stopwatches and tape measures have been brought out to measure a man's sexual potential. When the media puts forth the idea that the fulfilment of a person's sexuality is the responsibility of the man and his erection, one wonders how happy women end up in all of this", Koiso-Kanttila contemplates.
According to him, young people's possible problems have to do with nervousness and performance anxiety.
"In such a case the entire person should be treated, not just in the Viagra sense."
According to male researcher Arto Tiihonen, the emphasis on the erection has much to do with the change in male sexuality. The male body has become an object, in the same way as the female body used to be.
"In my own youth in the 1970's it was thought that there is nothing uglier than a beautiful man. Now men's cosmetics is the fastest-growing industry", Tiihonen says.
At the same time society and sex have become more performance-oriented. People used to think that the relationship comes first, and that sex is just one part of it. Now young men are asking on Internet bulletin boards, if performance enhancers would help when one-night stands make them so nervous that their members fail to function.
"Perhaps one should be nervous. Sexuality is a powerful experience, but it is just one part of a relationship. Sex is closely related to the security brought by a relationship", Tiihonen examines.
"People do not need to copulate all the time. At least our civic morality has not condoned such behaviour for thousands of years."
Young men do not generally seek medical attention for their mental issues. Jaska from Eastern Finland buys his drugs from the black market.
"The market for pirate drugs is huge. Some of my friends order them online, some bring them from abroad personally. They have always been available one way or another.
He believes that he could also talk a doctor into writing him a prescription. "I just have not gotten around to asking, since the drugs are much more expensive if bought legally."
The popularity of online ordering can be seen in at the Finnish Customs Service. The amount of confiscated illegal impotence drugs has quadrupled this year. In the beginning of the year, over 100,000 pills had been found. According to Senior Customs Inspector Mika Pitkäniemi, impotence pills bought without prescription are confiscated from holiday travellers every day.
Pills bought from the Internet or on an Estonian street corner are obviously not manufactured by any official pharmaceutical company. Most of the illegal drugs are cheap copies or ineffectual placebos made in Indian sweatshops.
According to Ahonen, most of the illegal pills contain mainly lactose, which is harmless, but ineffective.
"This fits perfectly: erectile dysfunctions are often psychological in nature, so even a placebo can offer help. Personally, I would never take medicine, the precise content of which is uncertain"
Chemically-induced erectile infallibility is not entirely risk-free.
For example the common side effects of short-term use of Viagra include headache, redness of skin, and a prolonged erection. Nobody knows what kind of effects prolonged use may cause.
The worst-case scenario is that a person who has started using the drugs at the age of 18 finds himself unable to achieve erection without them at thirty.
"The knowledge about all new drugs is quite limited when they are first brought into the market. It is impossible to even speculate the long-term effects of the use of impotence drugs", says Riitta Ahonen.
Many promising new drugs have proven to be flawed. For example the painkiller Vioxx was pulled from stores because of the heart symptoms it caused.
"So far, an effective drug without any side effects has not been discovered. The question is, how severe side effects can be condoned", Ahonen states.
The possible side effects of impotency drugs do not concern Jaska.
"I do not believe that there is anything wrong with the illegal pills. It would not be in the manufacturer's interest to sell dangerous drugs. And I have not read that long-term use would have negative effects", Jaska states.
"I use them so seldom in any case. About four times a month."
Helsingin Sanomat / First published in print 30.7.2006
PERTTU KAUPPINEN / Helsingin Sanomat
perttu.kauppinen@hs.fi
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| 1.8.2006 - THIS WEEK |
 Get up, stand up |
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