Viva Viagra?

     Pfizer will begin offering online sales of their popular selling erectile dysfunction treatment. The company believes this will help combat online sales of counterfeit Viagra. While a prescription will still be required, this is supposed to help men avoid "embarrassment" by saving them a trip to the pharmacy to pick up the medication. Currently there are dozens of online sites that sell the little blue pill for a fraction of the price without a prescription. Unfortunately, these pills are often counterfeit containing very little of the active ingredient and even potentially harmful components. Pfizer believes by offering discounts to online consumers they can try to push out the black market vendors.

Photo: Niko J. Kallianiotis for The New York Times (link to article)

     Personally, I think cutting out the pharmacist sets a horrible precedent in the pharmaceutical industry for several reasons. Of course, I'm concerned by anything that threatens the role of the pharmacist in a retail setting. I don't know where I'm going to end up after pharmacy school and I don't want to see pharmacists taken out of more and more patient interactions. It may just be Viagra today, but what other medications will be available directly from the manufacturer if this is allowed? Secondly, this could potentially be dangerous. Many people think of Viagra as a harmless treatment for erectile dysfunction akin to the "treatments" we see advertised on late night TV. Viagra is a serious drug with serious side effects and the potential for deadly interactions with other commonly prescribed drugs. For example: many men with erectile dysfunction are also on blood pressure medications and these two mixed together can cause an unsafe, dramatic drop in blood pressure that can even lead to cardiac arrest. That's great men still need a prescription from their doctor to acquire this drug, but a doctor is not a drug expert and may not catch potential drug interactions like a pharmacist would. Pharmacists are also more accessible than physicians to answer patient concerns and address patient issues on the spot.

     Finally, I don't really think this will stamp out the problem of counterfeit, black market Viagra. One of Pfizer's main arguments is that patient embarrassment will be avoided. I can't speak from personal experience, but I would think a patient that would be embarrassed to pick this up from the pharmacy would be too embarrassed to bring this issue up to their doctor in the first place. That's the nice thing about black market drugs: you can order them without ever having to bring up your erectile dysfunction to even a doctor. I work in a retail pharmacy and I have never had a guy act embarrassed about picking up their Viagra. In fact, most of them act proud (for lack of a better word). They should be proud that they can even afford to take it, since insurance often doesn't cover it. Which brings me to another point: the black market drugs are so much cheaper. Even with their discounts Pfizer can't compete with the prices of the counterfeit Viagra.

In my opinion if Pfizer wants to help combat black market sales of Viagra they need to educate their potential customers on the dangers of counterfeit medications AND the danger of using a drug without their doctor/pharmacists knowledge. Stick with what you know Pfizer. You keep cranking out your little blue pill and let the pharmacists sell them.

The Future of Pharmacy = Provider Status



ASHP article

Ram Samudrala and his CANDO attitude!

     Straying from the topic of compounding... sort of. Recently, I went to a seminar hosted by the Medicinal and Natural Products Chemistry department in the College of Pharmacy. I think I mentioned this in a previous post, but my interests tend to be like love affairs: I'm instantly enchanted by something, spend all my time with it and profess my undying love for this topic then move on to something else the following week. This week it is definitely the Computational Analysis of Novel Drug Opportunities or CANDO. This is a computer program/database created by Ram Samudrala (http://en.wikipedia.org/wiki/Ram_Samudrala). You know you've made it when you have a Wikipedia page, right? Anyways, the database contains all known drug target structures and all known drug structures. The analysis comes in by screening all of these targets against the known compounds. Picture a database full of literally thousands of nuts and bolts, the computer then goes through all of these to see which nut fits which bolt and makes connections between similar nuts and/or similar bolts in a large web of information.
    The compounds and their targets are broken down to the active fragments of their molecules. Here's where the compounding part comes in: with this program it is possible to take components of active drug compounds and fit them together in new way to possibly hit new targets or optimize their efficacy and safety. I don't know about you, but this stuff blows my mind. It's like something from science fiction! Of course further testing in vitro and in vivo would be required to confirm the compounds actually work as we would like them, too. For example just because a drug will kill a bacteria doesn't mean it can even get to the spot it needs to. Bacteria can develop ways to evade active compounds like efflux pumps and other defense mechanisms.
     If the compound studied is already FDA approved, but is discovered to work on another illness then many steps in the drug discovery and testing process can be skipped. This creates a faster, cheaper method of discovering new drugs. The program can even run all known homo sapien proteins against bacterial proteins and drug compounds. This way researchers can see what compounds act on bacteria and not humans predicting toxicities and efficacy. Check out the links below for more information.


http://compbio.washington.edu/
http://cando.compbio.washington.edu/