Urologist recommends daily Viagra to prevent impotence

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:9
  1. Ray Moynihan
  1. Washington

    Sildenafil (Viagra), which is approved to treat erectile dysfunction, could now be taken daily to prevent it, a high profile professor of urology has advised.

    Professor Irwin Goldstein of Boston University, Massachusetts, said at a recent continuing medical education event (sponsored chiefly by the drug's manufacturer, Pfizer) that he was a “strong believer” in taking sildenafil on a daily basis to “prevent impotence.”

    Before a large audience of primary care doctors and others attending a sexual function update at New York University in December, Professor Goldstein said he had “hundreds of men” using Viagra for prevention: “If you would like to be sexually active in five years' time, take a quarter of a pill a night—we have data to show that will facilitate and prolong nocturnal erections.”

    His comments were made during a panel session, in response to a question from one of the event's directors, Dr Natan Bar-Chama, a urologist from the Mount Sinai School of Medicine, New York, who also told the meeting “I'm a strong advocate of proactive prevention as well.”

    Dr Bar-Chama initiated the exchange by asking the assembled panel whether there was a role for sildenafil-type drugs in daily use. It appeared that the question was one of several collected from the audience on pieces of paper before the session started, although Dr Bar-Chama said later during an interview that he had thrown in the question himself.

    The basis for the endorsement comes from a small study by Montorsi and colleagues (Urology 2000;56:906-11) involving 30 men on three nights' use of sildenafil, a drug that Professor Goldstein described as a “miracle drug.”

    Other sex researchers have reacted to the endorsements with alarm: Dr John Bancroft from Indiana University called them “quite scary,” and Dr Leonore Tiefer from New York University and a critic of company sponsorship of educational events said they were “bordering on preposterous.”

    Plans to publish the event's details on the internet will ensure a wide audience for the comments, and any subsequent move from sildenafil being prescribed as a treatment to being prescribed as a five times a week preventive drug would clearly expand sales for Pfizer dramatically.

    When asked whether either doctor had ties to Pfizer, Dr Bar-Chama replied, “On occasion I speak for them” but said he held no stock.

    Dr Goldstein said, “I consult with and lecture for virtually all the pharmaceutical and implant manufacturers” but added that he had no stock concerns with any company.

    Dr Goldstein also dismissed questions about a potential closeness in relationships with sponsors, saying he also told the New York event that sildenafil had a 50% dropout rate. “I'm allowed to say what I want … No one tells me what to say.”

    Guidelines of the Accreditation Council for Continuing Medical Education state that “a provider shall have a policy requiring disclosure of the existence of any significant financial interest or other relationship” between speakers and relevant manufacturers, yet it remains unclear whether anything was disclosed to those attending the New York meeting.

    Pfizer's Urology Group leader, Dr Michael Sweeney, said that Dr Goldstein was recognised as one of the most “enthusiastic” members of his specialty but emphasised that the company had not yet seen convincing data to recommend sildenafil's daily use. (See Education and Debate, p 45.)

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    A Viagra a day … may keep impotence at bay

    (Credit: KOBAL)