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PRESCRIPTION FOR DEBATE
Will Viagra change the way Americans view sexual health? May 15, 1998 |
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Questions asked
in this forum:
What liabilities do doctors face if Viagra causes long-term side effects? Can Viagra help a low libido? How successful would a blue "sugar pill" be? Can Viagra be habit forming? Are insurance companies guilty of a double standard? 
Douglas Wood of San Diego, CA asks: How much of Viagra's effect is physiological, relative to its psychological effect? How successful would a blue "sugar pill" be?
Ira Sharlip responds:
The clinical research trials of Viagra were double-blind and placebo- controlled. This means that half of the patients were given Viagra and half were given a placebo ("sugar") pill and neither the patient nor the physician knew which patients were given Viagra and which were given placebo. In the various studies, which were conducted both within the U.S. and outside of the U.S., 70-90% of patients treated with Viagra had a good response. In the placebo arm of the study, 20-40% of patients reported as good a response to placebo as the patients who were on Viagra reported. These studies show that there is a large psychological element in ED. Nevertheless, Viagra works pharmacologically in at least 50% of men and produces psychological and/or pharmacological benefit in a large majority (70-90%) of men.
Paul Wolpe responds:
For whom? It works far better than placebo in men with organic impotence. For men with primarily psychogenic impotence, I don't believe anyone really knows. There has not been a systematic study that I know of comparing the effects of Viagra in men with psychogenic impotence to matched controls.
Eileen Palace responds:
I refer this viewer to my responses in Questions 1 and 2. Findings from my program of research on the psychophysiology of sexual arousal and response at Tulane University Hospital and Clinic's Center for Sexual Health show a direct pathway where changes in response expectancies have and immediate impact on actual physiological processes. Physiological and psychological effects are necessarily inseparable. I have empirical evidence of a common "mind-body" pathway for cognitive processes (such reactions to stress) to affect physical functioning and conversely, physical functioning to affect psychological health.
I have examined this viewer's question in my research (not with Viagra, but rather by increasing blood flow with exercise and action-adventure films). Because I have shown that positive expectancies increase actual vaginal blood flow within 30 seconds, it is interesting to raise the question of how effective a "placebo" blue pill might be in raising expectancies. I found with my "placebo" charts showing increased genital arousal (positive-false feedback), that they were extremely effective in increasing expectations of sexual arousal, and in turn, directly increasing actual physiological response and subjective perceptions of arousal. This pathway between cognitive and physiological response is extremely rapid, and demonstrated by the finding that positive changes in expectation were accompanied by significant increases in genital response within, 30 seconds of exposure to an erotic stimulus (Palace 1995, 1996). However, when accurate feedback is provided to dysfunctional women without the physiological component (without increasing blood flow), low physiological response exacerbates the dysfunctional process by validating negative expectations ("See, I knew it wouldn't work tonight"). The active (not placebo) effect of the physiological treatment therefore is important because by increasing blood flow, the positive-false feedback can be replaced by positive-true feedback (i. that is, the physiological component [blood flow] works and the expectations are realistically increased, in a positive cognitive-physiological spiral of heightened sexual arousal.
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