Manipulating the Hispanic Market: The Case of Viagra

More than 350,000 prescriptions of Viagra were filled the 3 weeks after Pfizer launched the drug to treat erectile dysfunction (ED). Viagra is currently used by 20 million men in 110 countries. With annual sales of over $1.5 billion but facing increasing competition from other ED drugs, Pfizer has left no potential market niche untouched.

In this effort, Pfizer has enlisted the all-too-available support of the Interamerican College of Physicians and Surgeons, a not-for-profit organization founded in 1979 to “promote cooperating among US Hispanic physicians and to advance their professional and educational needs.” As part of its activities supported by “an unrestricted educational grant from Pfizer, Inc.,” the College convened a roundtable of physician experts to discuss the diagnosis and treatment of ED. The results of this discussion have now been published in Spanish and sent to a broad roster of Hispanic/Latino physicians. The report, titled Rompiendo el Silencio de la Disfunción Eréctil (“Breaking the Silence on Erectile Dysfunction”), purports to provide pointers to Spanish-speaking physicians concerning Latino patients and their presumed reticence on the topic of ED. But the publication is also a blatant infomercial for Viagra. The drug’s safety and efficacy are touted, with references to the one research study – funded by Pfizer, of course – that included Hispanic American men with ED. And care is taken to suggest a response for any patient who should balk at the drug’s cost. Not affluent? Not insured? The doctor is advised against not prescribing solely because of the patient’s inadequate health coverage: “The correct questions may elicit coverage unknown to the patient or his eligibility to receive additional benefits.”

If the fact that the Interamerican College has lent itself to being an unabashed promoter of a particular drug were not offensive enough, the offense is compounded by the patronizing tone of the suggestions and its obvious exclusions. Predictably, the text begins with a discussion of machismo, or masculine pride, because of its obvious links to a reluctance to address ED.

Under the banner of cultural competence and sensitivity, the report then goes on to generalize about Latino patients, oblivious to the fact that in-group differences may trump any pan-Latino similarities. The importance of respect and courtesy are stressed, as should be the case with all patients. In the case of Latinos, however, certain key phrases are suggested as verbal signs of respect: for example “Con su permiso” (with your permission) is recommended before beginning a physical examination. Similarly, the pointers play on the idea of Latinos as “touchy-feely” and doctors are urged to place their hand on the patient’s shoulder or pat them on the back. Describing the Hispanic community as “profoundly spiritual,” the report also suggests tapping into religious beliefs to connect with patients. One member of the expert roundtable prescribes using the phrase “God willing” – most often associated with other-worldly powers, fatalism and resignation – as one that projects encouragement and warmth.

Equally disturbing is the text’s obvious exclusions and myopia when addressing gender-related issues. Perhaps because all the physicians invited to the roundtable were men, the publication assumes that all doctors are male. As a result, no mention is made of female physicians in their interactions with patients. Similarly, patients’ sexual partners are assumed to be female; the concerns of men who have sex with men therefore go unmentioned. The report thus falls prey to the same sexual taboos it is attempting to address, even as the Viagra market owes a significant share of its sales to gay and bisexual men.

We should not be surprised that Pfizer should seek to woo all potential allies in its quest for greater market share. But we would expect that a not-for-profit professional organization be less eager to sell its name to a purely commercial enterprise which obliterates any distinction between education and propaganda. And we would also hope that “cultural sensitivity” not serve as an excuse to reinforce sexual and ethnic stereotypes.