Until now, Viagra was the only oral treatment for erectile dysfunction on the market, and its creator Pfizer reaped blockbuster returns. But thanks to new drugs from GSK/Bayer and Eli Lilly, the father of all marketing battles has begun.
At a home game of the Philadelphia Eagles American Football team on the first Sunday of December last year, the giant symbol of a burning flame flashed up above the locker-room tunnel as the players ran onto the pitch.
Meanwhile, hundreds of miles to the north at Gillette Stadium in Boston, home to the New England Patriots, the same mysterious burning flame lit up the electronic billboards that ring the ground. It also flashed across the giant TV screen, positioned high above the crowd. What is this burning flame? A new symbol known only to football aficianados? Something to inspire the teams and their supporters, perhaps?
No. It's the logo for Levitra, a new drug from GlaxoSmithKline and Bayer, and a competitor for Viagra, the best-selling anti-impotence medicine discovered and marketed by the American drugs giant Pfizer.
'If you're trying to reach men, you want to go after them where they are - and 100 million men are watching football every week,' says Michael Fleming, a spokesman for GlaxoSmithKline. 'We want to make sure men are aware of this new option.'
Over the next few months, the typical American sports fan will be exposed to similar reminders of the fragility or otherwise of his manhood, as he settles down with a few beers and a bag of pretzels to watch his favourite ball game.
While GlaxoSmithKline is using football to push the merits of its drug for a spot of post-match relaxation (assuming, of course, that your team won), rivals have been backing other sporting events. Pfizer has sponsored a Viagra car on the NASCAR racing circuit, and Eli Lilly, which is launching Cialis, its own runner in the impotence race, has put its name on a yacht in the America's Cup.
The impotence wars are now in full swing - and it looks set to be one of the hardest-fought battles the pharmaceuticals industry has witnessed in ages. For the past five years, Pfizer has had the market to itself with its top-selling Viagra. Now GlaxoSmithKline and Bayer are pushing Levitra, and Eli Lilly is pushing Cialis.
The impotence market is one of the big new targets for the drugs business.
Since it was introduced in the late 1990s, Viagra - known by industry wags as the Pfizer Riser - has become a pharmaceutical blockbuster. It has been taken by 20 million people around the world. In the US alone, 12 million men (plus, allegedly, a few curious women) have swallowed the little blue pill. Pfizer claims that it is the world's most recognised drugs brand.
In an industry that has struggled to come up with innovative new medicines, Viagra is one of the few big success stories. Among drugs developed in the past decade, only Prozac has the same sort of public profile. True, Viagra's usefulness to bar-room comedians can exaggerate its economic significance. In the latest quarter, it had sales of $437 million, making it only Pfizer's sixth-biggest drug. Nevertheless, it's an important market and a growing one.
Levitra was developed in Germany by Bayer, and it is being marketed jointly by the two companies - a recognition that this product will need a lot of promotional support. That push is huge: Credit Suisse analysts estimate that the two firms may spend more than $100 million between them as they try to establish their brand in the market.
All that money is aimed squarely at one target: the men who haven't tried Viagra yet. Giovanni Fenu, head of global strategic marketing at Bayer, estimates that 150 million males around the world suffer from erectile dysfunction. So far, fewer than a fifth of them have tried Viagra.
For Levitra, GlaxoSmithKline and Bayer are going directly for the guys market. Like beer and car manufacturers, they want men to know about their product, and that means sport, sport and more sport. As well as sponsoring individual football games in the US, GlaxoSmithKline became one of the founder sponsors of NFL Network, a new channel launched in November broadcasting American football 24 hours a day.
It also signed NFL football coach Mike Ditka. 'I use it and it works for me,' he said in TV interviews to help promote the drug. 'Men can be very macho; they don't want to talk to people about their problems. But if they don't talk about their problems, they can't fix them.'
There's nothing new about celebrity endorsement of impotence drugs. Pfizer used the former Republican presidential candidate Bob Dole (who was defeated by the unquestionably virile Bill Clinton) as one of the launch spokesmen for Viagra. It does, however, illustrate a shift of emphasis: Viagra went for an elder statesmen; Levitra is being promoted by a young and active sports coach. In response, Pfizer dropped the superannuated Dole as the face of Viagra, and hired Rafael Palmeiro, a Texas Rangers baseball star who has hit more than 500 home runs in his career.
GlaxoSmithKline pulled out all the stops for the launch of Levitra in autumn 2003: the company sees it as one of its key drugs over the next few years. Its target is annual sales of $1.1 billion. In the first six weeks on the American market, it calculated that Levitra captured 12% of impotence prescriptions.
As well as marketing razzmatazz, there is some science to the battle.
Although all three drugs work by inhibiting an enzyme called PDE-5 - causing the smooth muscle in the penis to relax and resulting in increased blood flow - there are reported differences in their effects. GlaxoSmithKline reckons about half of Viagra patients were not satisfied with the product. In clinical trials, it found that men for whom Viagra had proved ineffective were three times more likely to be able to complete intercourse with Levitra than they were with a placebo. So some of those Levitra prescriptions may come from Viagra users, but by no means all of them. GlaxoSmithKline claims that 38% of its American prescriptions were written for men who were not previously taking medication for impotence.
Eli Lilly is taking a softer approach to the market. If Levitra wants to be the medicine for real men, Lily's latest drug claims to be the choice of the new man. The pitch: Cialis is the romantic choice. The name of the drug is derived from the French (the most seductive of languages) word for sky. The key claim is that the effect lasts for 36 hours: take the pill and it will help you achieve an erection any time in the next day and half, compared with a window of opportunity of a mere four or five hours for either of its two rivals.
Focus group research, according to Eli Lilly, shows that Viagra has acquired some rather tacky associations in the mind of the public - lace teddies, high heels and champagne glasses. Cialis, on the other hand, conjures up images of fluffy bathrobes and soft pillows. An early choice of theme song for TV ads was the old Supremes hit You Can't Hurry Love. That was ditched in favour of a treatment showing couples caressing to a soundtrack of mellow jazz. The tagline: 'When a tender moment turns into the right moment, you'll be ready.'
So how do the different drugs stack up against each other? According to a pithy, if rather graphic, account in a recent report from independent London research firm Drug Analyst: 'The current marketing platforms of the three drugs works something like this. If you want a quickie (a fast erection), you are likely to be better with Levitra. If you want to last all weekend, or are uncertain what time you are going to pull, then you want Cialis. If you aren't sure and as long as it gets there in the end, then you should stick to Viagra.'
Pfizer, meanwhile, is punching home the point that 20 million men have already taken Viagra, and the drug has a good safety record. Said Pfizer chief executive Henry McKinnell at an analyst conference in October: 'New competition not only increases awareness and causes more men to see doctors, but highlights the differences between Viagra and the newer-to-market products, which don't have the safety and efficacy record that Viagra does.'
All the companies are prone to bickering about which of the three drugs works best. Last November, a conference of the European Society of Sexual Medicines heard research by Hartmut Porst, a professor at the University of Bonn in Germany. In a study of 150 men, Porst found that 45% preferred Cialis, 30% voted for Levitra and just 13% opted for Viagra.
Pfizer wasn't taking that lying down. As soon as the research was published, it rushed out its own statement, accusing Porst of not being scientifically rigorous. It wheeled out a different study, this time by the University Clinic in Gastuisberg in Belgium, which showed that of 91 long-term Viagra patients, only 21% preferred one of the new medicines.
When the companies aren't arguing about the science, they are arguing about the law. Pfizer is suing Eli Lilly, GlaxoSmithKline and Bayer, arguing that both Levitra and Cialis infringe its patents on Viagra. It is demanding that sales be blocked, and any profits made from the sale of the drugs handed over to Pfizer. Meanwhile, the US patent office has decided to review the original patent on Viagra.
If that disappears, any generic manufacturer could move into the market with its own cheap copy of the drug.
There is little sign of a ceasefire - and the battle has turned global.
The impotence warriors subtly vary their message according to the country they are operating in. Take Levitra: in Britain, the line is the undeniably raunchy 'There are erections, and then there are 3D erections'. In Germany, it is the slightly threatening 'Amor trifft wieder', or 'Love strikes again'. In Spain, however, the focus of the ads is on bringing couples closer together, reflecting the more gentle Mediterranean sensibility.
The companies are sensitive to charges of over-selling. When the New York Times ran an article and editorial accusing GlaxoSmithKline of turning Levitra into a lifestyle drug, the company was quick to deny it. It likes to play a straight bat, insisting this is a serious medical condition and Levitra an important medicine.
Still, there is no denying that a lot of money is at stake. The battle of the impotence drugs had now commenced. The only issue is how long all three companies can keep it up. mt
STAYING POWER: Why Viagra will be hard to dislodge in Europe
Inevitably, the marketing of impotence drugs is much more low-key in Europe than it is in the US. Flashy sports sponsorships and the high-profile endorsements are unknown on this side of the Atlantic, for the simple reason that direct-to-consumer marketing of prescription pharmaceuticals is banned.
So you are unlikely to see John Major or Gary Lineker popping up on TV, advertising the benefits of Viagra, Levitra or Cialis for their love lives.
Instead, the drugs companies adopt a much quieter approach to raising awareness of their products: the marketing is soft-core rather than hard-core.
Websites and associations are one method. Pfizer supports the Sexual Dysfunction Association, which also runs a website called impotence.org.uk.
It is full of useful information and, in fairness, does not try to push the advantages of one drug over another. Despite the financial support from Pfizer, the site has impartial descriptions of all three drugs.
The aim is to make more men aware of the treatments and get them into their doctor's surgery to ask about the drugs. Much of the marketing effort is is channeled into visiting GPs and trying to persuade them of the benefits of a particular medicine. All three pharmaceutical companies put emphasis on PR. Articles on the issue in the health pages of the newspapers are the best way of raising awareness, together with studies by research institutes - many of which are funded by drug companies.
A consequence of this method of promotion is that it is much harder in Europe to persuade men to request one of the three medicines by name.
This may make it tougher to dislodge Viagra, which has a huge lead over its two rivals in brand recognition here - Viagra's market share in the UK held up well in the months immediately after its rivals were launched.
When you hear the first Levitra or Cialis joke in a bar, you'll know that Bayer, GlaxoSmithKline and Eli Lilly have succeeded.