Sildenafil citrate (VIAGRA)

British men, particularly those between the ages of 20 and 44, tend to have sex more frequently according to a national survey, but the state-funded National Health Service has been recommending one little blue pill a week for patients suffering from impotence.

“Certainly for the young patients, those in their 40s, once a week wouldn’t be enough,” Adrian Cook, a researcher at Imperial College of Science, Technology and Medicine in London, told Reuters.

“The policy needs to be revisited and the evidence needs to be looked at more closely,” he added.

The government introduced the restriction on Viagra, which is made by the American drug giant Pfizer Inc., after it was launched in Britain because it feared costs would soar if it was available on demand.

Free prescriptions were limited to men suffering from prostate cancer, multiple sclerosis, spinal cord injury, kidney failure and other serious conditions.

Pfizer went to court to make the drug more widely available by having the restriction declared unlawful but was unsuccessful.

Cook and his colleagues, in a letter published in the British Medical Journal, urged the government to reconsider its policy. They said their analysis of data from the national sexual survey shows that the prescribing policy is unjust and is not satisfactory for many men.

“It discriminates in two ways. It identifies certain groups who are eligible for treatment and that is quite an arbitrary grouping. There is also the frequency type of rationing and that is not evidence based. It certainly mitigates against the younger sufferers,” Cook said.

The Department of Health said it advises doctors that one treatment a week will be appropriate for most patients, but doctors can exercise their own judgment and prescribe more.

“The current system was introduced in 1999 to get a balance between treating men with impotence and protecting NHS resources to deal with other priorities including those with cancer, heart disease and mental health problems,” it said in a statement.

An estimated 2.3 million men in Britain suffer from impotence, or erectile dysfunction, but only about 10 percent receive treatment, according the Impotence Association.

Patients who do not qualify to receive the drug on the NHS can get it prescribed through private doctors.

Two other anti-impotence drugs, Eli Lilly & Co.’s Cialis and Levitra from Bayer AG and GlaxoSmithKline, have also been launched in Britain. All the drugs are similarly priced at $30.86 (19.34 pounds) for a pack of four tablets.

So what of the future? As I predicted several years ago, the Viagra stampede has settled down, with a brisk black market developing, accelerated by the Internet which allows more than 70 million male web surfers to get in touch with other men who have got hold of tablets for their own use, that they are willing to sell at grossly inflated prices. In addition a large number of online pharmacies have sprung up offering Viagra without a medical consultation, at heavily discounted prices.

Generic Viagra is also widely available, made by companies who are breaking the patent ownership. And then there is fake Viagra, containing little or no real Viagra.

Viagra will undoubtedly be shown to have some other undesirable side effects as time goes by. Expect Viagra (and the new generation of other drugs with similar action such as Cialis) to become widely used and abused by the wealthy of every nation, with refusal of governments and insurance companies to pay for Viagra without strong medical evidence of sexual dysfunction. This will cause embarrassing problems for them. How do you assess erectile dysfunction except during the act itself? Other tests give partial results. A generation of men will find, for once in their lives, that they are being encouraged to boast about how poor their sexual performance is, to try and convince doctors to part with another Viagra script.

Viagra is set therefore to join the growing family of other drugs like steroids as a performance enhancing drug for the healthy, and possession without medical authority is likely to be banned in due course by some governments who will see Viagra as a drug associated with abuse.

A class of drugs used to treat erectile dysfunction may one day help delay or even prevent heart failure in patients with the most common forms of muscular dystrophy , according to a study published in the May 13 issue of the Proceedings of the National Academy of Sciences.

Duchenne muscular dystrophy is a progressive muscle-wasting disease that primarily strikes boys between ages 2 and 6 years old. It affects all voluntary muscles, including the lungs and heart. Most patients die before age 30. Duchenne muscular dystrophy and a less severe variant called Becker muscular dystrophy affect about one in every 3,500 to 5,000 boys in the United States.

Maya Khairallah of the Montreal Heart Institute and colleagues assigned mice with muscular dystrophy to either a placebo or Viagra . The mice received the drug once a day for six weeks.

Imaging tests showed that the mice that received Viagra had improved heart performance.

Viagra is a type of drug called a phosphodiesterase type-5 (PDE5) inhibitor. It blocks the enzyme PDE5 and prevents the breakdown of a natural substance called cyclic guanosine monophosphate (cGMP).

Khairallah’s team also discovered that having a gene that increased cGMP production helped maintain normal heart function in mice with muscular dystrophy.

The findings support existing theories that defects in the cGMP signaling pathway play an important role in the development of muscular dystrophy-related heart muscle problems. The study’s authors believe their research suggests that the evolution of heart problems in muscular dystrophy patients could be prevented by partially restoring this pathway. Therefore, medications that increase cGMP signaling, such as Viagra, may prove to be a novel therapeutic approach for the treatment of muscular dystrophy-related cardiomyopathies (heart muscle problems) in the future.

The researchers encourage future studies to determine whether PDE5 inhibitors could delay, prevent, or even reverse the onset of heart injury and loss of function in patients with Duchenne and Becker muscular dystrophies.