Pfizer markets Viagra as a treatment for erectile dysfunction. By what ever means physicians arrive at the definition of erectile dysfunction, ns there is no doubt that the target market for its treatment (and the financial success of that treatment) rests in the fifty - plus age group of American males - the demographic cohort most at risk for heart ailments stemming from cardiovascular disease and high blood pressure. What is more, in its roll call of the organic causes of erectile dysfunction, Pfizer specifically names the drugs that are prescribed to treat high blood pressure and heart disease as contributing “to a man’s inability to get and keep an erection”Il9 and recommends Viagra as a treatment. So Ian Osterloh’s claim that “we thought [heart and high blood pressure patients] wouldn’t be thinking about sex” rings hollow; Pfizer both anticipated an interest in sex among men with high blood pressure and heart disease and systematically kept such men from its clinical trials.

Here, I’d like to turn to a discussion of risk and redemption. Pfizer Pharmaceuticals (Brand Viagra manufacturer) claims that it expected more deaths. But why? What is it about sex that drives thousands (if not millions) of American men to compromise their health, whether by ingesting a pill or through physical exertion? The answer, again, may be found among James Doyle’s five themes of American masculinity. Socialization emphasizes both virility and achievement as imperatives for the performance of masculinity. “Be sexual,” “Be aggressive,” and “Be successful” all come into play here. In childhood, boys are rarely reprimanded for risky behavior; in fact, risk - taking behavior among young males is rewarded by peers, if not by parents. Organized sports - particularly football 12 I - often intensify the performance of risk taking and aggression, as physical training emphasizes strength, the endurance of pain, and, above all, winning. This adolescent socialization, of course, becomes part and parcel of adult masculine socialization, albeit more subtly. Viagra “works” on several levels because it provides men with an assertive (or active) role in their treatment and, as it is advertised in the popular press, this treatment promises success. Most importantly, it does so without compromising a man’s status in his social hierarchy. The way in which these news stories address the issue of death calls attention to the fact that death is always big news. This is not surprising. No matter what the context or circumstanceswhether the issue is an airplane crash, disease, or catastrophe - the drama of death is exhaustively narrated and examined in the media. And after scenes have been created and recreated, shock has been expressed and acknowledged, and the aggrieved have been listened to and consoled, the question of blame surfaces and demands a response.

Some articles blame Pfizer and others blame people. Pfizer is drawn as a company that is irresponsible: in testing Viagra, in ignoring the myriad health problems of the drug’s target market, and in pressuring the FDA in the interest of profit and stock prices. People are blamed for not taking the drug as directed, for being out of the hegemonic masculine loop, for wanting better sex and sensory experiences, and for performing sex irresponsibly /illegitimately. Most apparent in these reports that attempt to make sense of fault is that Pfizer, as much as the media doing the reporting, exculpates itself and directs blame toward the users of its drug.

With regard to these legitimized risks of Viagra, there is more to be revealed. Data in the Journal of the American Medical Association indicated that 564 Viagra - related deaths had been reported through July 8, 1999 - a mere fourteen months after Viagra was approved by the FDA.122 And in January 2003, researchers at the University of Chicago discovered how some of those deaths were not the simple result of combining Viagra with contraindicated nitrates, but rather, from unexpected platelet clumping” Inexplicably, none of the news sources considered here reported these findings.

Clearly, as evidenced by the comments from spokespersons dismissing the risks of its product, Pfizer has demonstrated its commitment to profits, rather than any of the altruistic motives some of its literature boasts. For Pfizer, these deaths signify an embarrassment more than a legitimate hazard for which it might be responsible. Dead men tell no tales. Newsweek’s John Leland writes, “To atone, let us now honor the Viagra 130, those brave men who died before they could fulfill the drug’s true promise: to spew intimate details from the boudoir, preferably in public, even in front of the kids. ”

In the final section of this post, I look at how the rhetoric of the social “costs” ofViagra continues in a larger institutional structure. The fifth major theme of the news stories I examine is the economic impact of Viagra on a societal scale.

Finally, nonimpotent heterosexual males are portrayed as illegitimate users and scapegoats, but in a different way. From the “be careful what you ask for” department appear the cautionary tales of men who “just want some fun. »

These stories stress the fact that Viagra is not an aphrodisiac and only intended for “the clinically impotent patients for whom it was intended.”1l2 These men, too, are subject to side effects - in particular, priapism, a prolonged, painful erection that, if untreated, can cause permanent impotence. But there is a wink - wink, nudge - nudge quality to these warnings, as well.1l3 Indeed, many of these articles fully acknowledge Viagra online nefarious uses. One such user proclaimed that Viagra “helped him last twice as long as usual.”1l4 Another discloses, “My girlfriend always knows when I use it …. Instead of this carefully choreographed single episode, suddenly I’m a nuclear reactor of 10ve.”1l5 Such exposure is, without question, good for Viagra’s reputation among men. Indeed, my own unsolicited informants have revealed a similar response. None of the people who’ve told me they’ve used Viagra has ever had it prescribed to them personally - such a revelation would be tantamount to admitting that they had erectile dysfunction - rather, it is always acquired through a friend or relative, giving the “street” distribution of Viagra an urban legend quality. Susan Brink writes, Tested and approved for erectile dysfunction, [Viagra] is almost certainly being used to enhance sexual performance, a purpose for which it has never been tested …. It’s practically impossible to curtail such “off - label” drug use, since physicians can prescribe drugs for any purpose they choose and drug companies are always looking to expand their rnarkets.

Pfizer can (and does) play both ends against the middle here. By condemning these off - label uses, Pfizer demonstrates its corporate responsibility even as it enjoys the financial benefits of such underground talk - true or false. The illegitimate users are already society’s scapegoats: drug users, homosexuals, and, to a lesser extent, lascivious heterosexual single men and some married men (who use Viagra only with mistresses). Meanwhile, the popular press legitimates the rightful users, even those whose penchant for risk taking earned them the final reward.

As these news sources allay the possible detrimental effects of Viagra, they create the likelihood of risk - taking behavior. For legitimate users, the possibility of regaining lost erectile function trumps the threat to general health and well - being. Because the loss of erectile function so threatens a loss in masculinity, many men turn uncritically to the promise of technoscientific marvels like Viagra. Likewise, the news stories legitimate its use among men at risk, equating the FDA’s approval with objectivity and ignoring the subjectivity of individuals.

receiving calls from Pfizer representatives.

Pfizer spokeswoman Maryann Caprino said the warning about nitrates appears in Viagra’s federally approved package insert. But, she said, “You can’t use words like ‘poppers’ in your insert.” And sales representatives making the rounds to New York doctors in the last two weeks “could only talk off the package insert,” she said, which meant they couldn’t use the word poppers, either.l°2

After receiving a warning from a representative of an advocacy group, a physician with a large gay clientele “began warning patients about not mixing poppers and Viagra.” He thought a call from Pfizer to activists (and not physicians) was “a funny way to tell people.”103 By early 1999, however, Pfizer explicitly included a warning on its patient summary information about “poppers.” When asked about a public education campaign for gay men, Pfizer responded that such a campaign was only “a possibility.”

Over four years later Pfizer still hadn’t produced any educational literature for gay men. An October 2001 New York Times story, “Experts Fear a Risky Recipe,” reports how [Pfizer spokesman Geoff Cook] said he did not know whether the company would pursue a gay - oriented educational campaign. He stressed, however, that Pfizer had long warned against the use ofViagra for nonapproved purposes …. “Our position to not use Viagra for recreational purposes is well - known, but any pharmaceutical product can be abused,” Mr. Cook said. He added that Pfizer also advised caution when the drug was used with protease inhibitors, an important class ofHIV medications.

By this account, it would seem that Pfizer equates gay sex with the adjectives “recreational” and “nonapproved.” Writer David Tuller opens the story by acknowledging the similarities between gay men and straight men: “Many gay men, like straight men, are using Viagra solely for its approved purposeas a remedy for persistent erectile dysfunction.” He then chastises gay men for “treating [Viagra] as a recreational drug and taking it along with Ecstacy [sic] and other illegal substances.” The article includes examples of medical misfortunes befalling gay men who’ve combined Viagra with other drugs (including poppers). Distressingly, the article singles out gay men using Viagra as contributing to the spread of HN through a roundabout argument that would have readers thinking that all gay Viagra users have multiple partners, are recreational drug users, and frequent bathhouses. Fortunately, this news story does attempt a reflexive stance when Tuller reports that it is unclear “whether Viagra use itself can lead to an increase in risky behavior or whether those who tend to engage in risky behavior are simply more likely to take Viagra.” He adds, Some Viagra advocates say the drug may actually reduce HIV transmission by making it easier for men to maintain erections while using condoms. And others say that focusing on recreational Viagra use among gay men smacks of prejudice.?

Given the prevalence of straight men using Viagra even under the threat of death, heart attacks, and the panoply of other side effects, I would suggest there is prejudice at work here. And if Pfizer is marketing its product to straight men for whom procreation is no longer a goal (and, in some cases, impossible) then it seems clear that cultural constraints against sex as recreation is something reserved only for gay men. The double use of the adjective “recreational” for gay drug use and gay sex maligns both.

Perhaps what is surprising is the extent to which this phenomenon of risk taking at the expense of health is understood, condoned, and reported by the popular press. By June 1998, when the first sixteen deaths had been reported, Newsweek journalist Rana Dogar discloses in her article “Just How Safe Is Sex?” that the details of each death aren’t yet clear. … But there appear to be some common denominators. At least 13 ofthe men were reportedly over 50, the keyage for both heart attacks and Viagra use. Many suffered from ailments like heart disease or high blood pressure; some were taking medications for them.

In the New York Times) Gina Kolata defends Pfizer’s position when she writes, “Of course, patients taking nitroglycerin have serious heart disease so even if such patients died while taking Viagra, that in itself would not mean that they had died because they had taken Viagra. “96 Newsweek’s John Leland also effects a remarkably benign position when he concludes, “The risks, though, are easily inflated. . . . Most of the men who died were elderly, and 51 had other risk factors like high cholesterol, high blood pressure or diabetes. “97 The ways in which these news stories characterize the deaths that followed the ingestion of Viagra legitimizes both the response of Pfizer Pharmaceuticals and the larger societal structure that grants the process of developing drugs to organizations with a primary focus on profit.

But the risks ofViagra could not be completely ignored. Death notwithstanding, these news stories had other ways to talk about the perils of the potency pill. Along with legitimizing risk, many of these news stories located illegitimate risk. In order to appease the public’s interest in safety and to demonstrate responsibility, these news stories concoct numerous scapegoats upon whose backs the burden of evil is loaded.

In his introduction to Kenneth Burke’s Permanence and Change) Hugh Duncan explains how the use of the scapegoat is “only a rationalization of other motives” including sexual, political, and economic motives.w In The Rhetoric of Religion) Burke differentiates between the ritualistic scapegoat and the pseudoscientific scapegoat. In ritual, the scapegoat is “delegated” insofar as the attributes in need of purgation are contrived. But for the pseu - doscientific scapegoat, negative attributes have been retroactively assigned.

These negative attributes disproportionately fall on “queer” users of Viagra. By “queer” I refer to those who, according to certain writers, ingest Viagra illegitimately - that is, those outside of the boundaries sanctioned by Pfizer, by techno scientific discourse, and even by society at large. Performance studies scholar Elizabeth Bell points out how “each culture maintains elaborate cultural constraints against and rewards for coupling in/appropriately.”loo In these news stories, those men who couple inappropriately - or, illegitimately - and are made scapegoats as a result include homosexuals, rave party drug users, and nonimpotent heterosexuals (both male and female).

By July 1998 - barely three months after Viagra’s release - the FDA had received reports of seventy - seven deaths.sf Major side effects occurred by the hundreds, according to the FDA, including nonfatal heart attacks, strokes, and impaired vision. Even as the public was made aware of these side effects, Pfizer’s consumers revealed their biases. In Newsweek a sixty - four - year - old Maryland man remarks with characteristic masculine bravado, “I think about [the risk]. But the tradeoff is worth it.”86 In the New York Times a man opines, “Some of these old guys will drop dead from it. ”

In a May 1998 New York Times article, Jane Brody reports how “in the wave of enthusiasm surrounding this drug over the last two months, many physicians and their patients have ignored its limitations and side effects” and that “millions of sufferers are likely to forsake caution.”88 Published some nine months after Viagra came sailing into the harbor of the public’s awareness as the “potency pill,” Shannon Brownlee’s U.S. News & World Report article, “Dying for Sex,”89 encapsulates the casualties attributed to Viagra and intimates the causalities. In particular, Brownlee is suspicious of the methods by which Pfizer managed the drug’s clinical trials and the FDA’s approval process. And by the time her report hit the newsstands, the FDA had confirmed that at least 130 Americans had died after taking Viagra.w Brownlee’s article is not the first among those surveyed to report on Viagra’s impedi - ments, but it is the first to provide critical analysis that points out the possible obliquities practiced by Pfizer Pharmaceuticals and the FDA. Brownlee’s thesis is twofold. She first argues that Pfizer’s clinical trials failed to include patients with heart problems: The company went to full - scale clinical trials, using sildenafil to treat impotence in more than 3,000 men. The researchers were careful to exclude men with serious heart conditions or high blood pressure, or those who had had a stroke or heart attack in the past six months.

The second part of her thesis is that the FDA moved too quickly in approving Viagra, without its usual and necessary precautions: “The drug’s approval came just as Congress was concluding four years of congressional pressure on the FDA to approve drugs - even lifestyle - enhancing drugs - more quickly.”92 Brownlee’s article is supported by illuminative expert testimony. The rebuttals provided by Pfizer, however, are the most revealing; Pfizer is shameless in its refusal of accountability.

A required component of the male sex role is independence. Men are supposed to be self - reliant and confident, never admitting to a lacR. In a New York Times article a man recalls, “[My wife] wanted me to sex a doctor because I no longer had erections. ” Meanwhile, he is less than toncerned, busying himself with his golf game and ignoring the relational fallout. “To tell the truth,” he confesses, “I was more concerned about my putting than playing around. “Another article in the Times illustrates another kind of aloofness. A man who has had erectile dysfunction (the result of testicular cancer) since the beginning of his marriage confides, “One thing that amazed me when we finally opened the lines of communication was that my sexual performance was not satisfactory for her. “62 In the same article, another man suggests that ED “isn’t an easy topic to deal with” because “it goes to the heart of masculinity. ”

Independence, heterosexuality, and penetrative sexual activity are dominant themes in these online testimonials. Altogether, they signal the motif of status as an important consideration for the men portrayed in these news stories. What is more, men maintain both status and the mind/body dichotomy by utilizing metaphors to describe their bodies.

Because virility is viewed as an integral part of what it means to be masculine, a loss in virility is often considered a loss in masculinity: “I feel less than a man,” comments the subject of a Newsweek article.e - Uncertainty and real or imagined deficiency of one’s virility generates an “othering” of the fallen phallus. It is not the man who is lacking but his member. This transfer is carried out through the use of mechanistic metaphors, for example, the title of a 1997 Newsweek article by Geoffrey Cowley: “Rebuilding the Male Machine.” In its perceived failure, the penis goes from erect and performing phallus to an object as useless as “a flat tire”65 or stopped - up “plumbing,”66 or as revealing as “a chink in their armor. “67 Likewise, the solution or recovery is viewed “as insurance,”68 “a full tank,”69 or a “revolution”

The men using these metaphors take their cues from medicine. Dr. Irwin Goldstein is one urologist and researcher who sees the process of erections as a mechanical one. Profiled in Jack Hitt’s February 2000 New York Times Magazine feature story about the medicalization of sexuality, Goldstein works with Drs. Jennifer and Laura Berman at Boston University’s Sexual Health Clinic. This is the team that treated Bob Dole. Goldstein remarks: Not to discount psychological aspects … but at a certain point all sex is mechanical. The man needs a sufficient axial rigidity so his penis can penetrate through labia, and he has to sustain that in order to have sex. This is a mechanical structure, and mechanical structures follow scientific principles …. I am an engineer … and I can apply the principles of hydraulics to these problems. I can utilize medical strategies to assess, diagnose and manipulate things that are not so straightforward in psychiatry.”

“The penis as a ‘tool,’” writes Peter F. Murphy, “makes explicit the association between male heterosexuality and the machine.” Murphy’s website Studs, Tools, and the Family Jewels examines the metaphors men live by as well as the shrewdness of discourse common among heterosexual males.

The penis as a device for performing a chore or doing a job is one metaphor that dominates the lexicon of male bonding. The idea of the penis as an instrument to accomplish something (usually penetration of a woman to allow a man to have a quick and easy orgasm), or as an implement to get a particular job done, pervades the way men think about their sexuality.

This points to another important meaning of the word “tool” - it is also used to describe those who blindly follow artificial standards. A tool here is an “implement” of oppression - a dupe, a stooge. A tool is somebody who, unthinkingly, does what he is told to do. If the penis is supposed to function when called upon to do so, then there is a clear hierarchy between a man and his penis. In these news stories, this hierarchy is maintained - both by patients and physicians - through the use of mechanistic metaphors. But it is in adolescence that this hierarchy is established.

In the discourse of erectile dysfunction, the benchmark for healthy sexual response is based on recollections of youth and/or early relationship activity. From the “I wish I knew then what I do now” department comes the idealization of youthful sexuality, as evidenced by comments made by those for whom Viagra has worked successfully. “I’m 60 years old but I think I’m 16″73 and “It’s time for me to be a stud again”74 are two examples of how the recovery of erectile function is equated with reminiscences of a glorious sexual past.

It is has been argued that women experience distinct, biological moments that punctuate the course of their lives whereas men do not. Whether or not these moments are absent for men, women’s biological experiences are imbued with cultural significance; menarche, menstruation, pregnancy, and menopause not only mark time in a woman’s adulthood but are also indicative of sexual readiness, availability, and outcome.Zf That is, in a culture of male dominance, women’s bodies are marked. With regard to men’s bodies, no matching reproductive indicator is available, nor is there an expectation of changing function. Once boys reach puberty and begin to experience erections and produce sperm, science tells us there is little variation on sexual physiology until death - at least nothing as dramatic as pregnancy, nor as culturally loaded.

Health communication researcher Michael Arrington’s research of prostate cancer patients in a support group reveals how a culture of marginalization and silence is likely perpetuated by social structures rather than a lack of interest in the topic of sexuality. When a psychologist replaced a physician as the facilitator of this support group, the group’s members were provided with a space to talk about emotional issues, physical pain, and sexual intimacy. Arrington found that these men were able to “negotiate sexuality with their partners in a wide variety of ways, ranging from abstinence to redefining sexual intimacy to seeking other forms of intimacy altogether.” The definition of “real” sex - defined as spontaneous penile - vaginal penetration - is one that begins in adolescence. Changing that definition might require a shift in consciousness, something that a serious illness and/or a tal - ented facilitator might enable. Online testimonies of masculinity contained in these news stories suggest a puerile and stagnant relationship between men and sexuality - one that Viagra preserves with its emphasis on subtlety, organic causes, and universal remedies. These testimonials - which feature status, mechanistic metaphors, and youthful virility as their primary themes - reinforce how the male sex role is steeped in tradition and slow to change. But here I must ask as others have - Are these roles actually what men perform, or what they are expected to perform? And if these roles are expectations, who is the audience? Because definitions of American masculinity are so carefully regulated through models of hegemony and the practices of complicity, it is not surprising that these testimonials replicate traditional norms. But the perpetuation of norms (whether or not they are performed) does have a price. This price is evidenced both by the lengths to which men will pursue the sexual expectations of heterosexual masculinity and by the costs absorbed by the state in that pursuit. As Lynne Segal observes, Many feminists simply equate “masculinity” and “male dominance.” On this view the psychology of men inevitably perpetuates the social structures of male dominance, as a result of either their biological or their social construction [emphasis original]. As I’m sure Segal would agree, the perpetuity of male - dominated social structures is not a question of either biological or social interplay but of both/and. The three motifs of status, architectural metaphors, and youth comprising the theme of testimonials of masculinity demonstrate the degree to which the fantasy of hegemonic masculinity holds sway over the reality and inevitability of aging. The fourth theme wrenches that reality to the forefront.

The gfndered nature of communication styles has been a frequent site of academic investigation.s - Although early studies chose to address the ways in which mek and women differ in how they participate in a communicative event, more recent investigations into the nature of communication have come to recognize the importance of describing gendered styles as masculine and feminine. Nevertheless, masculine styles and feminine styles typically correspond with men and women, respectively. Those who employ a feminine style of colmmunication do rapport talk, while the masculine style is orchestrated around the strategy of report talk. Deborah Tannen explains: For mdst women, the language of conversation is primarily a language of rapport: a I way of establishing connections and negotiating relationships …. For most men, talk is primarily a means to preserve independence and negotiate and maintai!n status in a hierarchical social order.

Even though we’re not talking here about conversation per se, an analysis of masculine Itestimony about sexuality can take into account the same stakes. For many romen, talk about sexual practices is about relationship validation. A mutual !acknowledgment of barricades to the bedroom authenticates the partnership. While often an occasion for braggadocio, sex talk for many men draws attention to inadequacies - a direct affront to male status - not only in relationships, but also in the real and imagined arena of men. Indeed, a patient’s 14ck of erectile function prompts the writer of this passage to steep him in a f9minized countenance: The patient … was accidentally kicked in the groin years ago. The damage was severe. A beefy, rounded man, he sits on the examination table sidesad1dle, his ankles crossed coyly. Both he and his Rubenesque wife curl their shoulders inward and keep their heads bowed, as if in shame [my emphasis]. This man clearly lacks the markers of masculine status and, instead, is portrayed as the embodiment of feminine deportment. An example of elevated status, on the other hand, can be found in Geoffrey Cowley’s Ne,sweek article in which a man banters with his physician about the success of his hormone therapy: “My wife would like a word with you … and th1at word is stop. “57 In this instance, the man’s recovered virility is an occasion to elevate his status among men. I

If erectile dysfunction is regarded as a couple’s disease, the Viagra online is depicted as the couple’s cure. The testimonials offered in twenty - four separate news accounts reinforce the importance of communication about sexual activity and happiness (through sexual fulfillment) in relationships. Communication between partners about sexual preferences, turnoffs, and frequency is essential to the successful relationship according to physicians, sex therapists, counselors, and the partners themselves. But although references to marriage, partners, and sexual relationships were regularly featured aspects of these news stories, specific examples of dialogic comrnunication were rare: Viagra users, their physicians, sex therapists, and counJelors constantly refer to sexual fulfillment but always from a hypothetical and/or generic sense. The few examples that are included construct an overwhelming assumption of marriage (or, at least, monogamous heterosexuality) among Viagra users and reinforce status as a traditional aspect of! masculine communication style.