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Weekend House Call

Aired August 24, 2003 - 08:29   ET


ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. Look out Viagra, there's a new competitor on the market. On Tuesday the Food and Drug Administration approved a second anti-impotence drug, it's called Levitra. This pill is orange instead of blue should give Viagra a run for its money, and as Susan Lisovicz reports, a third alternative is not far behind.

SUSAN LISOVICZ, CNN CORRESPONDENT (voice-over): If the sexual revolution began with the birth control bill, then it got its second wind with Viagra. The breakthrough pill to treat male impotence has become, in five years, one of the best known brand names in the world. Viagra claims about 3 million users in the U.S., but analysts say the market is much bigger than that.

TONY BUTLER, ANALYST, LEHMAN BROTHERS: The number of people approaching the age of 50 is increasing in every year.

LISOVICZ: That sets a stage for a little known rival that has now won FDA approval named Levitra.

UNIDENTIFIED MALE: Levitra? Levitra, that's a new word in my vocabulary.

UNIDENTIFIED MALE: Is that a French word? No? Levitra? Never heard about Levitra in my life.

LISOVICZ: But, Levitra is well known in more than 30 countries where it is already sold. And while major league baseball has been used as a platform for selling Viagra, Mike Ditka will pitch Levitra in a campaign timed to coincide with the start of the football season. Still another competitor, Cialis is expected to get government clearance soon. Cialis also sold overseas has been dubbed the weekender because it lasts up to 36 hours. Experts say the market potential is tremendous.

DR. IRWIN GOLDSTEIN, UROLOGY PROF. BOSTON UNIV.: I have a very important phrase. The penis knows no loyalty. I think that men who have had erection problems don't need to stay with a certain therapy if it's not giving them the response that they would like.

LISOVICZ: The pills are similar in their pricing and the way they work.

(on camera): One striking difference may be the approach advertisers take in tackling this most sensitive of male problems. Levitra is expected to appeal to women, to get their men out of denial and over to a physician.

Susan Lisovicz, CNN, New York.


COHEN: You should be able to purchase Levitra sometime in the next few weeks. You'll need a prescription from your doctor and the cost should be comparable to Viagra, which runs about $10 to $12 a pill. Insurance usually covers Viagra and is expected to cover Levitra, as well. About 30 million men have erectile dysfunction, but only one in five seek help. The side effects of Levitra are the same as Viagra, and they can include headache, facial flushing, stomach upset, nasal stuffiness and a bluish hue to vision. But there appears to be less of a vision problem with Levitra.

We want to answer your questions about these new anti-impotency drugs and don't worry we'll talk about options for women, as well, and some of the causes of sexual dysfunction. So, call us at 1-800-807- 2620 or e-mail your questions to

We have one of the nation's foremost experts on this subject with us, Dr. Irwin Goldstein joins us from Boston to answer your questions. He's a urology professor at Boston University's School of Medicine.

Thanks for joining us, Dr. Goldstein.

GOLDSTEIN: Hi, Elizabeth, how are you today?

COHEN: We're doing great. We're very excited. We have lots of people e-mailing us and calling in, so we want to get right to our first viewer question. It's an e-mail from Douglas in Maine, he asks, "I've heard Levitra is supposed to provide a faster reaction time and have a longer effective window. Is that fact or fiction?"

Does Levitra work faster and does it work longer, Dr. Goldstein?

GOLDSTEIN: Well, Levitra does act fast and it does act long. We have data to show that it acts in 15 minutes and that it lasts, you know, probably up to 15 to 18 hours. We do need head-to-head comparative trials to make comparisons among the various medications, though.

COHEN: We have a phone call, now, from Irwin in New Jersey.

Irwin, welcome to WEEKEND HOUSE CALL and go ahead with your question for Dr. Goldstein.

IRWIN, NEW JERSEY: Yeah, hi, Dr. Goldstein. Dr. Goldstein...

GOLDSTEIN: I like you are first name, Irwin.

IRWIN: Yeah, it's a good name. I like it. I just want to just to bring out one thing first, is that I am a diabetic and I have been taking -- what is it? Viagra. And I've been taking it for a couple of years, and the price of it is very high, and it works on me, you know, and -- but I have to wait a while for it to take effect. And I was just wondering how long does it take with Lipitrol to take effect and how much would the price be compared to Viagra?

COHEN: So, Irwin, Irwin has a question about price. Now, that there's going to be competition for Levitra, do you expect to see the price of these drugs go down?

GOLDSTEIN: I'm just a physician. You have to ask the drug company for price issues. But, you know, just getting back to Irwin's issue, diabetes is a real big problem. It's a huge issue in men, and impotence is really common in men with diabetes. And the real message for Irwin is go get help. There are new drugs available and other therapies, even if these drugs do not work. So stick with it, Irwin. We'll help you.

COHEN: We have a question from Dan from Los Angeles. Dan wants to know, "When will the new drug Cialis be released for the U.S.?"

Dr. Goldstein, do you have any idea?

GOLDSTEIN: Again, you know, that's an FDA issue. One would think either at the end of this year or early next year it should be available to the public. You can get it, if you wish, online, because it is available in many places in Europe.

COHEN: And, do all three of the drugs work in a similar way?

GOLDSTEIN: They sort of work the same way. They have different biochemical characteristics, but they end up blocking a very critical enzyme inside the penis, which ends up increasing blood flow and improving the erection in someone with an erection problem. They're really remarkable advances to our field.

COHEN: And, why would you rather use one than the other? I know you've done studies involving all three of them -- different studies. Is there -- is one better for certain men than the another one?

GOLDSTEIN: You know, we don't really know that yet. But, we do know each drug stands alone as a safe and effective therapy, and it's quite obvious -- and we have anecdotal information that one patient does well say, with Levitra as opposed to Viagra. We'll have to work that out. I think people will need to try and find out which works better for them.

COHEN: Well, we want to welcome to WEEKEND HOUSE CALL Arthur. He's calling from Nevada.

Arthur, go ahead with your question.

ARTHUR, NEVADA: Yes. I've been told by my physician that Viagra is not safe for people with glaucoma. How will this other pill actually differ or will it?

GOLDSTEIN: Well, that's a -- Arthur, that's a great question. There are certain side effects that the medications have that end up being contraindication. The most important contraindication is the nitroglycerine use. If you have a heart problem and you take nitrites, you're not allowed to use these kinds of drugs. But, glaucoma is not really a problem for Viagra. There are certain eye problems, retinitis pigmentosa issues that you shouldn't use Viagra. But, glaucoma is not an issue, and it's not an issue for Levitra or Cialis. So, why don't you get another opinion and see if you can get on to these medications.

COHEN: I'm going to ask callers to stand by, now. We've got to take a quick break.

When we come back, all the pills for men -- is there anything to help women with sexual dysfunction? We'll have that answer and we'll take more questions. Call us at 800-807-2620 or e-mail at



QUESTION: What are your immediate thoughts when I say Viagra?


UNIDENTIFIED FEMALE: (LAUGHER) Well, surely it's a case of do you -- does he -- he doesn't need it, you see? We're married. We've been married a long time.

QUESTION: What's your reaction about -- you know, a sex pill for women?

UNIDENTIFIED MALE: I think that's a good thing. Hey, young, old, hey, that's all good.


COHEN: Well, this guy's all for it. This is WEEKEND HOUSE CALL and we're talking about new anti-impotency drugs and sexual dysfunction. It's a sensitive issue for men and women. Call us with your question, the number's on your screen, 1-800-807-2620 or e-mail us at

While we get your phone calls lined up, let's check the "Daily Dose Health Quiz." Today's question: How many Americans use Viagra?

We'll have that answer in 30 seconds. So stay with us.


COHEN: Checking our health quiz, we asked, "How many Americans use Viagra?"

The answer: Viagra claims 3 million users in the U.S. worldwide. It made $1.7 billion last year and the company that makes the drug, Pfizer, will proudly tell you nine Viagra pills are dispensed every second. Pfizer spent a lot of money on advertising and Viagra outsells Levitra and Cialis overseas.

Welcome back to WEEKEND HOUSE CALL. We're talking about the new anti-impotence drug Levitra. Levitra and Viagra are safe for most men, but there's one group that absolutely should not using it. Those taking nitrate medications, such as nitroglycerine, to treat chest pain, or alpha blockers for blood pressure. Men with prostate problems should ask their doctor before taking these drugs and the FDA does not recommend them for people whose heart disease makes sex dangerous or who have had a recent heart attack or a stroke.

We have with us Dr. Irwin Goldstein, joining us from Boston.

Stacy from Texas wants to know, "Will Levitra work for someone who is not impotent? Someone who just wants to have longer lasting sex?"

Dr. Goldstein, this question came up all the time when Viagra came out. If you have a -- if you have a functioning penis, basically, and can have sex, will Viagra make things -- or Levitra make things even better?

GOLDSTEIN: I -- you know, with -- I've been asked that so many times. It's just like what you just said, we don't do studies in normal people, so we don't have the information from a scientific perspective. It's hard to make something 100 percent 100 percent. What impresses me is how many people say they don't -- they use these drugs, but then they say I don't really need it. I think what they're saying is they have a partial impotence or partial erection problems and would like to have better function and I think that accounts for many people who say -- well, I use it but don't really need it.

COHEN: Giacomo from Washington, D.C., is on the phone, Dr. Goldstein. He has a sexual dysfunction question.

Giacomo, go ahead with your question.

GIACOMO, WASHINGTON, D.C.: Thank you very much, Dr. Goldstein. I hope for a family, I have hypogonadism and I use Androgel to raise my testosterone level. But, -- and I can maintain an erection but ejaculation takes a very long time and creates very little see men. Will these new drugs help? Viagra doesn't seem to help in this problem.

GOLDSTEIN: Well, the -- you have a low testosterone or hypogonadism issue and the problem with ejaculation is very likely that you have limited sensation in the penile area, because an ejaculation response is a really a neurological reflex. Continue taking the therapy for hypogonadism, because it will make either Viagra or Levitra work much better. We have found hormones, like nerves, like psychology, like blood flow are all the critical things needed for erections and if you have low testosterone, you need to continue to take these medications.

COHEN: Dr. Goldstein, we have a call, now, from Jennifer in Pennsylvania.

Jennifer, go ahead with your question.

JENNIFER, PENNSYLVANIA: Yes. I just wanted to find out, you have so many things that are advertised for men, and I would say that there are a whole lot more women who have a problem, and I don't see anything advertised for women. Is there something out there for women?

GOLDSTEIN: God bless you, Jennifer.

JENNIFER: Don't you think that there's...

GOLDSTEIN: Thank you so much for calling.

JENNIFER: Don't you think there is more of a problem with women, too?

GOLDSTEIN: Oh, not only -- not only do I think that, but those are the facts. Actually, it's about one in three men, but it's a little more than 4 out of 10 women who have sexual problems. So, why do we spend all our time talking about men? At your clinic in Boston, we actually see more women than we do men, at our Institute for Sexual Medicine and the problems are more challenging, they're more interesting and I refer you to our Web site, if you wish, and we are looking very carefully into the basic science of vaginal physiology, clitoral physiology, g-spot physiology, etcetera to better understand to process. It's really time we spent more time doing the research in this area.

COHEN: Dr. Goldstein, the women are just lining up to talk to you. We have a phone call, now, from Patricia in Virginia.

Patricia, go ahead.

PATRICIA, VIRGINIA: Hi. Yes, I'm 52-years-old, I'm menopausal, and have absolutely no sex drive. Is there anything out there that can help women like me?

GOLDSTEIN: Oh, please. There is huge amounts that we can do for you. For all the women who are calling in, you know a detailed evaluation is required. A psychologic investigation, a medical history a sexual history, physical examination that is carefully performed with surgical loops to investigate the area in the vestibule and in the vulva, blood tests -- specifically about 10 to 12 hormone blood tests, quantitative sensory testing for sensation in the clitoris and labia area, blood -- genital blood flow testing. With all of this information, a plan can be put together for specific you -- specifically your issue with low interest. It's very common that you have a low hormone level and the hormone is called an androgen. There are seven androgens, a very common androgen that people know is testosterone and I would really encourage you to get this evaluation and these blood tests so we can help you. Our success rate with women, just like yourself, is over 70 percent after one year.

COHEN: Dr. Goldstein, is there a pill for women that's widely available? A pill for women with sexual dysfunction? GOLDSTEIN: Well, there is not yet any -- believe this or not, not yet any FDA approved pharmacologic therapies. There is an FDA approved mechanical therapy called the Eros, which is a clitoris vacuum therapy device, but -- and it's extremely helpful, especially in women with orgasmic problems, but, not yet a pill. I don't thing there can really be a pill until we understand the basic physiology and there needs to be huge research in this area. We know reproductive physiology, but not sexual physiology in women. It is amazing, but we don't understand how the vagina really works during sexual activity in the year 2003. It's very sad.

COHEN: So, just to recap what Dr. Goldstein just said, there are options for women experiencing sexual dysfunction. First and foremost, see your doctor, he or she can determine the right treatment for you. There are ointments and lotions available by prescription that are -- that can stimulate sensitivity and increase desire, also that device that Goldstein mentioned. The most important step is to talk to your doctor and realize that sexual dysfunction can be a problem for women, too.

We've got to take a quick break, now. When we come back, we've got a lot of e-mail questions that are lining up. They're asking -- will Viagra or Levitra ever be sold over the counter? We'll ask Dr. Goldstein when WEEKEND HOUSE CALL continues. Stay with us.




COHEN: Welcome back to WEEKEND HOUSE CALL. We're talking about the new orange pill to battle impotence, it's called Levitra and it just got government approval. Dr. Irwin Goldstein is here to answer your questions.

Let's start right off with an e-mail from Tomaso in Raleigh, North Carolina. He wants to know "Do you anticipate these drugs becoming available over the counter? And, if so, when?"

Now, Goldstein I know that you don't work for a drug company, but do you think they should be available over the counter, medically speaking?

GOLDSTEIN: It's an interesting question. I actually do believe they should be ultimately taken or available, like some of the new anti-histamines. You know, frankly, there's so much use from the Internet, so many of my patients are so embarrassed to go to doctors that they do this on the Internet. And, I think, actually, it makes sense to administer these kinds of sexual medicine pills this way. They're really safe and I think that's the most important item.

COHEN: Well, when they go over-the-counter we'll have to have you back on CNN.

COHEN: We have a call now... GOLDSTEIN: Thank you.

COHEN: We have a call now from Anna in Kentucky with a question.

Welcome to WEEKEND HOUSE CALL, Anna, go ahead.

ANNA, KENTUCKY: Yes, my husband had prostate cancer surgery about six months ago and he's not able to do anything at all. And I want to know if the Viagra or Levitra would help him?

GOLDSTEIN: Well, thank you for calling. This is a really, really important problem. Prostate cancer surgery often hurts the nerve supply and possibly the blood supply to the penis. Viagra and Levitra have been tried in these kinds of patients, but the results have not been as successful as in many of the other kinds of reasons for having erection problems. I would encourage the use of these agents, but if they are not successful, please go to your doctor. Injections of drugs into the penis -- I know that sounds bad -- but, we have many thousands and thousands of patients who do this very successfully. We use an insulin 30 gauge, smaller than a human hair -- needle to administer the drugs directly to the tissues with really nice and very positive results.

COHEN: How often do you have to get the injections, Dr. Goldstein?

GOLDSTEIN: Oh no, you don't have -- Elizabeth, you don't -- you only use it when you want to have intercourse. So, it's an issue -- you can use them daily if that's your hope and desire. But, rather than taking the medicine by mouth, it's basically taking the medicine by injection and they're designed for -- and they're really reliable to help get erections for intercourse.

COHEN: Well, thank you, Dr. Goldstein.

And, when we come back, we're going to have some final thoughts about sexual dysfunction. Join us. (COMMERCIAL BREAK)

COHEN: If you'd like for information on the new anti-impotence drug, and erectile dysfunction go to and click on the Levitra story. You'll also find a link to Boston University's Institute for Sexual Medicine Web site. It's a great resource for helpful information and insights.

Welcome back to WEEKEND HOUSE CALL, we've been talking about Dr. Irwin Goldstein at Boston University.

And, Dr. Goldstein, do you have final thoughts for our viewers with male or female sexual dysfunction.

GOLDSTEIN: First Elizabeth, thank you so much for doing this. Public education and public exposure about our field of sexual medicine is critical. Do not suffer in silence with this condition. There are many things we can do for both genders that can really help your quality of life. That is the message I would love to get across. COHEN: Well, thank you, Dr. Goldstein for joining us. That's all we have time for today. Make sure to watch WEEKEND HOUSE CALL next week, that's Saturday and Sunday at 8:30 a.m. Eastern, 5:30 Pacific. Watch CNN for all your medical news. This week, we'll follow a study on teens with major depressive disorder. We'll find out how safe it is to treat kids with antidepressants and we'll also be reporting on bionic baby boomers. Some high tech medical procedures are being performed on injured boomers, it's allowing them to continue living active lifestyles.

Thank you for watching. I'm Elizabeth Cohen. "CNN Sunday Morning" continues now.


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