Viagra blues

By Fatemah Farag

Viagra: a small blue pill with a big reputation. It is making the news, lots of money and, allegedly, a great many men very happy. But before you start to snicker or line up for your share of the fun you might want to consider some warning signs, signs the Ministry of Health is taking very seriously.

"Our decision is that the drug will remain illegal until we have had the opportunity to undertake the necessary studies into its properties and side effects," explained Dr Gamila Moussa, under-secretary for drug affairs at the ministry, following the announcement of the refusal to license the drug on Monday.

Approved by the US Food and Drug Administration late last March, Viagra has become -- according to published reports -- the most popular medication ever to hit the American market, attracting more than 40,000 prescriptions per day. Predictably, black markets quickly sprouted beyond American borders. In Taipei one pill is reportedly selling for $100. In Akhmeem, Sohag, the cost is a more modest LE75 per pill, at which price it is dispensed "only to people I like since demand far exceeds supply," said an Akhmeem pharmacist, speaking on condition of anonymity.

According to Egyptian law, all imported medications must first be approved by the Ministry of Health which fixes the price of drugs and organises their distribution through the Egyptian Company for Medication. And while Viagra has never been formally approved it is, for now at least, effectively banned. Such action was necessary, Dr Moussa insists, because "the media is making a myth out of this drug. Any druggist who sells it, or any other unlicensed drug for that matter, will face fines and/or imprisonment. We will find out because we routinely undertake surprise checks of pharmacies." In fact, since Monday, reports in the local press regarding Viagra confiscation have become commonplace.

A pharmacist in an upper class Cairo neighbourhood claims he does not sell Viagra but adds that many customers have come into the drugstore and complained when they could not find the drug. "They tell me it is all over the papers and that they want it. The problem is people do not realise that it can have serious side effects and druggists who are selling it illegally are taking a risk with people's lives. A man could get a heart attack taking that stuff."

Similar criticism of media and popular reaction to the drug was made by Nadia Wassef, principal investigator on the FGM task force project "Investigating the link between male sexuality and female genital mutilation".

"There is a very sensationalist approach which stresses the sexual rather than the health aspect of the drug. Take for example the logo of the pill with a smile on its face -- it is very misleading," she said.

But Pfizer, the company producing Viagra, is not complaining. Its shares have jumped 163 per cent, giving the pill its pet name: the billion dollar drug. And no surprise given that, in the US alone, the drug has an estimated 30 million potential consumers, men who experience "erectile dysfunction". And in Egypt a Qasr El-Aini study indicated that between 25-30 per cent of married men suffer from impotence -- 2.5 million people all of whom could be potential Viagra users.

When you take into consideration the alternatives to Viagra it is easier to appreciate the frenzy. Popular medicines aside, the only remedies for impotence to date, as reported by Time magazine, include gel suppositories, injecting drugs directly into the base of the male organ, vacuum pumps and penile implants. Yet despite the unpleasant nature of such treatments they are heavily advertised in Egyptian papers.

But the appeal of Viagra appears to extend beyond the impotent and many commentators fear that it feeds directly into a culture of machismo, boosting male egos that are already dangerously overweight.

"For men [sexual performance] seems to mean a lot, everything -- so all these men are going out of their minds trying to get their hands on the pill. On the other hand you have women who are perceived to be over-sexed and hence must be quietened down which is why you circumcise them," said Wassef.

A recent study by Kamran Ali, an anthropologist who undertook 15 months of fieldwork studying the concept of masculinity in Egypt reports that it is commonplace for men to use medication for the maintenance of erections.

At a popular market in Cairo Amm Abdel-Azim has dealt with these types of problems for years. Piled on the ground before him are packages of coloured herbs. "My stuff is cheap [50pt per package], it is natural and it is really good," smiles Abdel-Azim enthusiastically, giving me a "thumbs up" sign.

The seasoned vendor claims that aphrodisiacs are popular with men not because they are impotent but because life is tough and "these things" require an extra boost. His words echo the findings made by Ali who documented that men attributed poor sexual performance to poverty. The lack of energy-giving foods, combined with the belief that poor socio-economic conditions undercut their sexual appeal, led Ali to the conclusion that "poverty demasculises".

"Male sexuality is a big taboo and problems are well camouflaged," insists Wassef. Maybe, but for how long?