The Marlboro Man needs Viagra

This past June the California Department of Health Services announced its latest assault on tobacco - a $22 million advertising campaign aimed in part at young men 18-30 years of age. Funding for the campaign comes from Proposition 99, the 1988 ballot initiative which increased cigarette taxes and dedicated much of the revenue to tobacco control efforts. Among the 25 new radio, television, and print ads produced are a few that emphasise the link between smoking and impotence.

In announcing the campaign, Kim Belshe, the agency's director, noted rather discreetly that "The Marlboro Man may not be everything he's cracked up to be". Journalists were a bit more playful, picking up on the heavy media coverage surrounding Viagra (sildenafil), the new medication for male impotence. "The Marlboro Man needs Viagra", quipped the Associated Press. "What Viagra may give, tobacco taketh away." chimed in the Los Angeles Time. The San Francisco Chronicle reported that the campaign "takes aim at smokers-directly below the belt".

In a television ad (entitled "Gala Event"), a tuxedo-clad man and a woman in a low-cut gown are casually flirthing across the room at a private party. When the man lights up a cigarette, it goes limp in his mouth. The woman looks puzzled, then smiles derisively and walks away, while the narrator reports that "medical researchers believe cigarettes are leading causing of impotence". A big-band version of the song "I ain't got nobody" plays in the background. The tagline at the end reads, "Cigarettes. Still think they're sexy?" A companion print ad shows an attractive man with a flaccid cigarette hanging from his lips (figure).

"The recent extensive public discussion about male impotence has focused on the available remedies, especially Viagra," noted Dr Christopher Evans, assistant professor of urology at the University of California, Davis, School of Medicine, in a press release about the campaign. "This discussion has ignored the fact that many of the causes of erectile dysfunction are preventable. One of the leading preventable causes is smoking, which can adversely affect the circulatory system - an essential component of normal male sexual function."

The California campaign is not the first time, of course, that the link between smoking and impotence has been covered in the media or featured in an anti- tobacco campaign. A cover story in the April 1988 issue of Reader's Digest carried the headline "Warning: smoking endangers your sex life." Around the same time the Cleveland, Ohio television station WKYC ran a story about smoking and impotence ("another reason why your loved ones want you to quit smoking"). A print ad promoting the WKYC story (reproduced in Tobacco Control 1992; 1:241) featured phallic imagery similar to that used in the California campaign. The University of Central England gallery of anti-tobacco artwork, produced in conjunction with the Smoke Free Birmingham campaign (see the cover essy in the last issue of Tobacco Control, includes a drawing suggesting the beneficial effect of smoking cessation on sexual performance (figure).

Beyond these fleeting examples, the California campaign is probably the most ambitious attempt to link smoking and impotence in a public health campaign. If firm evidence shows that the campaign is producing its intended effect, tobacco control advocates in other venues may embrance the strategy in their own programmes. "Frankly", said health director Belshe, "it's our hope that men who won't quit to save their lives, to save their lungs, to save their hearts, may be more inclined to quit to save their sex lives."

Source: Tobacco Control 1998;7:227-231


Uprima (apomorphine) Shows Promise In Patients With Erectile Dysfunction

DEERFIELD, IL -- Data from three Phase III studies presented yesterday at the American Urological Association meeting in Dallas, TX., suggest that TAP Pharmaceuticals' dopamine receptor agonist, Uprima(TM) (apomorphine HCL tablets) sublingual, can increase the number of successful intercourse attempts.

Uprima is a central initiator that works by stimulating an erection through mechanisms originating in the brain.

"The results of this study are promising and provide hope for the approximately 30 million Americans who suffer from some form of erectile dysfunction," said Harin Padma-Nathan, M.D., director, The Male Clinic, Beverly Hills, CA., and an investigator in the studies.

Erectile dysfunction is defined as the inability to obtain and maintain an erection sufficient for intercourse.

The three studies were multicentre, double-blind studies where patients were randomised to four treatment arms of Uprima versus placebo -- 2 mg, 4 mg, 5 mg and 6 mg. The studies measured the number of attempts resulting in an erection firm enough for intercourse.

The first presentation consisted of data from a study that evaluated 520 male erectile dysfunction patients and found that the Uprima doses demonstrated a significantly higher percentage of attempts resulting in an erection firm enough for intercourse versus placebo (2 mg group -- 44 percent versus 38 percent; 4 mg group -- 58 percent versus 37 percent; 5 mg group -- 53 percent versus 29 percent and 6 mg group - 61 percent versus 29 percent; respectively).

The second presentation consisted of data from two studies and found similar results in hypertension patients. Hypertension is associated with erectile dysfunction. The study evaluated 977 patients, of which 236 were hypertensive and found that the Uprima doses also demonstrated a significantly higher percentage of attempts resulting in an erection firm enough for intercourse versus placebo (2 mg group -- 42 percent versus 32 percent; 4 mg group -- 51 percent versus 28 percent; 5 mg group -- 46 percent versus 30 percent; and 6 mg group -- 63 percent versus 33 percent; respectively).

The most common adverse event reported in these studies was nausea, mostly mild-to-moderate.

May 5, 1999