An effective critique of heterosexuality—at the levels of social structure, meaning, social practice and subjectivity—must contain two elements. The first of these is a critique of heteronormativity, of the normative status of heterosexuality which renders any other sexualities as “other” and marginal. The second is a critique of what some have called “hetero-patriarchy” or “hetero-oppression” … in other words, heterosexuality as systematically male dominated.

Just as cheap viagra marketing is invested in heteronormativity, it sells heteronor-mative values to the drug’s customers. Heteronormative values include traditional performances of both masculinity and femininity. Pfizer’s target market is the heterosexual man with the “wife” as the default “partner” when the relational dynamics of ED are described. While she might be frustrated by her husband’s erectile difficulties, she is patient and “stands by her man.” Within relationships marked by traditional performances of masculine authority and feminine servility, it is the woman who feels the pressure to equalize the anxiety resulting from the compromised male ego and the unresponsive penis. As evidenced by the design of the Sexual Health Inventory for Men (SHIM), “intimacy” means penile-vaginal intercourse and “sex” stands in for male orgasm. Testimonies of masculinity contained in the 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. Both Pfizer’s promotional materials and the news stories perpetuate traditional male sex roles by reproducing stereotypes of masculine behavior, beliefs, and values. Without these values the need for Viagra disap-pears, and the dominant socio/sexual order is threatened.

Buying Viagra on the Internet inhibits meaningful doctor - patient com - munication. The FDA Modernization Act of relaxed the restrictions of direct - to - consumer advertising: television advertising copy, for example, is no longer required to mention side effects. Rather, advertisers are required only to direct the consumer to other sources for information. The physician, then, “becomes the informational intermediary between the patient and the drug. ” The availability of prescription drugs on the Internet is cause for further concern as the services of physician/consultants are paid for by pharmaceutical companies, specifically to approve the prescriptions of online applicants.

The status of quality - of - life conditions is, of course, a huge “money” issue. Erectile dysfunction - as a quality - of - life condition - and Viagra - its cure - define expectations for “normal” masculine performances of sexual health. The fact that pharmaceutical companies drive these expectations for the primary purpose of increasing stock market share prices is extremely problematic. The introduction of quality - of - life condition reimbursement and treatment, in and of themselves, creates expectations for health coverage that will, no doubt, tax an already financially vulnerable and inequitable U.S. healthcare system. The body’s absorption of a pill - simple and discreet - has become, in microcosm, a symbol of the quick - fix mentality of a society not interested in repairing underlying and multiple causes. Expectations for the body, driven by financial goals, demonstrate the precarious relationships among political economy and identity, capitalism and sexuality, and gendered performances and normalcy.

This post has provided a retrospective of how Viagra has been reported in the news. The analysis uncovers hidden assumptions about the male body, male sexuality, and masculinity and health. These assumptions are not revised or transformed by Viagra; rather, they are upheld. Male bodies are expected to perform on demand - if not “naturally,” then with a naturally performing pill. Male sexuality is defined in one way; performing sexuality requires a mechanistic erection and vaginal penetration, even at the risk of one’s health. Ideally, sex mirrors the youthful experiences of early adulthood with frequent and explosive orgasms defining the norm for all men at all ages. Above all, heterosexual performances of sexuality are valued with deviant, or “queer,” performances scapegoated. These traditional expectations for sexual health are maintained by the current political economy.

Regarding the media in general and these stories in particular, it is significant that today’s Viagra news stories are no longer concerned with how the little blue pill impacts relationships or how taking it is potentially lifethreatening. Instead, stories revolve around competing pharmaceutical equivalents of Viagra (i.e., Cialis, Levitra). Today, stories in the media - by, for instance, CNN’s medical correspondent Dr. Sanjay Gupta - matter - of - factly report that million American men have erectile dysfunction without any of the critical feedback that a few stories in my sample provided. Here we see the difference between reporters (who merely parrot press releases) and journalists (who dig deeper). The next post, “Shims and Shills: Viagra and the Marketing of Transcendence,” explains how Pfizer’s own promotional materials have contributed to the absence of those important critical perspectives in today’s news stories about men, health, and erectile dysfunction.

Another debate over access to Viagra concerns its ease of acquisition on the Internet. Shortly after Viagra became available, news stories appeared that trumpeted the little blue pill’s other contribution to the health of the American man: more men were making appointments to see their doctor. “Men are so consistently no - shows at doctors’ offices that insurers have come to count on it,” writes Susan Brink in U.S. News & World Report. Viagra’s availability resulted in men keeping their appointments, enabling doctors to diagnose problems aside from (but related to) erectile dysfunction. In the New York Times) Fred Brock writes that “for every million men who asked for Viagra, it was also discovered than an estimated , had untreated diabetes, , had untreated high blood pressure and , had untreated heart disease.” Newsweek’s Dan McGinn confirms these estimates, adding that a heart disease diagnosis “warms the heart of Pfizer VP Marie - Caroline Sainpy, whose cardiac - drug team sells treatments for those ailments.” Why am I not surprised?

“Need Viagra? No prescription? No problem!” is the way online pharmacy advertisers pitch Viagra. Despite the manufacturer’s claims that erectile dysfunction is a serious medical condition that requires a physician diagnosis, Pfizer is not averse to Internet sales. Patient - physician communication in such a context is not capable of either diagnosing or treating the plethora of conditions of which erectile dysfunction is an unwanted result.

The procedure for ordering prescription drugs online was revealed in these news stories. At least two writers of the articles surveyed purchased Viagra over the Internet in order to demonstrate how easy this was to accomplish. In an article titled “Electric Kool - Aid Viagra,” Frank Rich of the New York Times reports that, after being charged a “consultation” fee and filling out an online medical history, a bottle of pills arrives by UPS from San Antonio, Texas. Of interest to Rich was the fact that he didn’t really have to communicate with a physician. He learns the name of his physician/ consultant only by reading the pill bottle: This doctor not only didn’t talk to me, but he didn’t consult with my primarycare physician to verify my purported medical history or see if I was telling the truth when I said I was not taking medications known to interact dangerously with Viagra.

Similarly, Jack Hitt, writing for the New York Times Magazine, fills out an online medical interview and answers a couple of questions. The next day, “barely hours after I had clicked the send button, the FedEx guy appeared with an envelope that rattled when he handed it to me.” Similarly, an article in U.S. News & World Report gives the details of a staffer who attempts to purchase Viagra online, including in the health questionnaire the fact “that he had had two open - heart surgeries.” Like Frank Rich and Jack Hitt, he too is “approved” and receives his supply of Viagra.

At the center of this debate is the question of the severity of erectile dys - function. Since ED is ” nonlethal and noncrippling,” states and insurance companies are loath to cover the costs of cheap viagrawhen other services would have to be limited, cut back, and/or eliminated altogether as a result of funding it. Meanwhile, Pfizer responded by saying that impotence “is a bona fide medical condition that has a tremendous impact on patients and their partners. ” Like New York and other states such as Wisconsin, insurance companies such as Kaiser, Prudential, and Humana expressed their reluctance to cover Viagra by pointing out how the cost for a drug that is medically unnecessary would infringe on treatment for more serious conditions. Other states and insurers required a documented diagnosis of organic impotence in order to qualify or “more stringent criteria for evaluating a patient’s medical need for the drug.” The military eventually “limited Viagra to men in whom erectile dysfunction has been diagnosed by a doc - tor.” Indeed, it was reported that even Secretary of Health and Human Services Donna Shalala considered Viagra’s potential for both clinical and financial abuse.

Another important consideration regarding Viagra’s impact on healthcare’s political economy was revealed when mandatory insurance coverage for Viagra catalyzed the discussion over birth control pills and their infrequent coverage. Carey Goldberg of the New York Times writes that, “For decades, women’s advocates had little success in pushing insurance coverage of contraceptives.” When Viagra was included in many insurance plans, ” these groups have been able to add to their arsenal of arguments the tough - to - beat issue of basic fairness. ” Opponents to contraception coverage ranged from the Catholic Church to antiabortion groups to business leaders to the U.S. Chamber of Commerce. While one - half to two - thirds of insurance companies do cover oral contraceptives, the significant differ - ence in overall out - of - pocket health costs between men and women - women spend percent more - can be traced to those insurance companies that don’t. In June , a federal judge ruled that not covering birth control “violated the Pregnancy Discrimination Act,” bringing the issue of coverage to a decisive moment.

As a nation, we do like our pills. A pill satisfies both our love of technoscience and our culture’s quick - fix mentality. Indeed, taking a pill is - in miniature - a useful metaphor for instant gratification.tzo As a culture, Americans have grown to rely on prescription drugs for both their efficacy and reliability.u? In her New YOrk Times report, Jennifer Steinhauer quotes Eileen Palace, director of the Center for Sexual Health at Tulane University who notes: We are in a very high - tech society, and people are used to having things done very quickly …. We saw in the s how the pill could control biology. Later we saw how to control fertility. People want a simple, easy, fast, solution. And many physicians assume that just because there is a physical problem means there is no psychological cause.

In a US. News & World Report article that gives a historical account of impotence “cures,” the president of the National Council Against Health Fraud agrees, “People want simple quick answers to complex problems.” The etiology of erectile dysfunction, the status of ED as a quality - of - life condition, and restrictions on prescription allotments are all controversial issues with tremendous financial stakes. Along with reports trumpeting viagra remarkable success as a treatment for erectile dysfunction came the specifics regarding Viagra’s popularity and economic impact. So it wasn’t long before government - sponsored Medicaid and a number of private insurance companies entered into the discussion. This subsection addresses how these three motifs - etiology, coverage, and prescription allotment - were reported in the news.

On May ,, Robert Pear of the New York Timesreported that the “Clinton Administration has told state officials that it intends to require their Medicaid programs to pay for medically approved uses of the impotence drug Viagra.” As states maintained that they should make their own decisions, lawmakers argued that “a nationwide mandate for coverage of Viagra through Medicaid would cost the states and the Federal Government more than $ million a year.” Because more than percent of Medicaid costs are absorbed by each state, some states argued that the cost would hinder the delivery of care to patients with more serious medical conditions. Amazingly, the federal directive requiring states to pay for Viagra was promulgated even as an increasing number of Viagra - related deaths were being reported. A spokeswoman for New York State Governor George Pataki said, “The Federal Government should not be requiring New York or any other state to pay for Viagra until there is a better understanding of the impact this drug has on patients. ”

Insurance company Kaiser Permanente similarly challenged the idea that a pill for erectile dysfunction would be something they would be required to cover. “Kaiser decided that it would not raise the premiums for all its members to pay for treatment of a nonlethal, noncrippling condition that almost all of its members could afford to treat on their own,” wrote Michael Weinstein in the New York Times.

The introduction of the subject of cost to both the state and private enterprise reopened the debate over both the severity of erectile dysfunction and Viagra’s intended use. What made Kaiser’s decision so interesting, according to Weinstein, is that insurance companies “often restrict or exclude treatments because of cost” but don’t usually admit that cost is the reason. Weinstein reports how decision makers for insurance companies “invoke code words - experimental, cosmetic, risky - to mask their motives, which they can’t say publicly. ” Kaiser estimated that adding Viagra to its coverage would cost the company (and eventually its members) $ million a year, “far more than it spends on all antiviral drugs, including the expensive drugs used to treat H.I.V.”

Insurance companies were not the only institutions that had to adjust their accounting estimates as result of Viagra. An October New York Times story revealed that the Defense Department had to adjust their budget to include Viagra: The Pentagon estimated that it would spend about $ million in the coming year to provide the impotence drug Viagra to American troops and military retirees …. Based on the number of soldiers, sailors, pilots, Marines and retirees who have asked for Viagra so far at military clinics and hospitals, Defense Department health officials estimated that if the drug were given to everyone who wanted it, the cost could top $ million.