In 2021, impotence affected as many as 16.5 million men in the UK; 50 per cent of the male population. But how many of them talked about it? To their friends, even to their partners? Men have always been tight-lipped about their problems – health problems even more so, and those related to impotence even more than that. Viagra, the little blue pill, provided what some saw as a lifeline for those struggling.
On December 29, when we're all deep into the days-long turkey sandwich and Baileys stupor, the BBC is releasing a film about a group of Welshmen who took part in the early Viagra trials in Swansea in 1994.
A fictionalised account of the true story, Men Up will follow five men, Colin White (Steffan Rhodri), Tommy Cadogan (Paul Rhys), Meurig Jenkins (Iwan Rheon), Eddie O’Connor (Mark Lewis Jones) and Pete Shah (Phaldut Sharma) who, for very different reasons, are looking for medical help with their corpus spongiosum (in layman's terms, erectile tissue).
Here's everything to know about the real-life story.
A stirring occurs
In the early Nineties, pharmaceutical giant Pfizer, now best-known for creating one of the COVID-19 jabs, created a drug to try and combat hypertension (high blood pressure) and angina pectoris (chest pain caused by heart disease). The drug, which would later be called sildenafil, was not yielding any breakthrough results in its Swansea trials. But it was producing erections in the men taking part.
Ian Osterloh, one of the scientists directing the sildenafil trials, wrote later in Cosmos magazine: "Studies were revealing more information about the biochemical pathway involved in the erection process. This helped us understand how the drug might amplify the effects of sexual stimulation in opening up the blood vessels in the penis. With chances of treating angina now slim, we decided to run pilot studies in patients with erectile dysfunction."
Medical repurposing
Noticing the effect of the drug, and after a series of more specific trials, Pfizer decided to market it for erectile dysfunction.
Sildenafil was patented in 1996, approved by the America's Food and Drug Administration (the FDA) by 1998, and went on sale in the US the same year. It was the first oral drug of its kind – a treatment which was being sold specifically to combat erectile dysfunction.
The trials
But before sildenafil was taken to the mass market, it had to be trialled for its final purpose. And so started the Swansea trials depicted in Men Up – and they included a measuring tool called the RigiScan and pornography. The story is as remarkable as the drug's far-reaching potential: many of the men who took part in the trial were reportedly former miners – not exactly the type of blokes who liked to talk sincerely about their medical problems.
One of Viagra's co-creators, Dr David Brown said: "They made history – they probably were just desperate to earn a bit of income but they've made a big difference to many people's lives and they should feel good about that."
British patients had to wait
Although it was the Welsh volunteers who were so integral to getting the drug to market, Viagra was not immediately made available to British patients.
A September 1998 British Medical Journal article said: "Following the advice of the Standing Medical Advisory Committee, the Department of Health has advised doctors not to prescribe sildenafil until definitive guidance is drawn up in the next few weeks. This is the first time that the NHS has refused to fund a licensed drug with proved benefits to a large number of people. The efficacy and safety of sildenafil has already been demonstrated in trials and use in the United States.
"Admitting that the decision was primarily because of cost, the health secretary, Frank Dobson, said: 'Media coverage of this drug to date has created expectations that could prove a serious drain on the funds of the NHS. If this were to happen, other patients could be denied the treatment they need. I cannot allow this to happen.'"
The article continued: "Another problem is the potential misuse of sildenafil, with healthy individuals taking it to 'pep up' their sex lives. Mr Dobson said: 'I don't really think that the NHS should be financing people waving their potency at a disco.'"
By July 1999, after a high court ruling and a lot of public pressure, the government finalised its restrictions: sildenafil would be available to around 20 per cent of the men who suffered from impotence in the UK. It would be prescribed for impotency related to physical issues, but not psychological issues.
What has writer and Executive Producer Matthew Barry said about the plot?
"I think what we explore in Men Up is the idea that men struggle to speak to other men about their problem," said Barry, whose credits include Industry and Casualty.
"The shame around impotency, especially in 1994, when there were no kind of real credible treatments, was a real issue. It’s been reported that, today, the second biggest killer of men between 18-45 is suicide. So, I hope what we’re doing is showing on screen that it’s okay to open up to a friend or family member and talk about what’s going on."
Barry worked with Dr David Price, one of the physicians who ran the trial, to properly understand the medical elements of the story. "This is a drama about one of the first ever anti-impotency drug trials in the world," said Barry. "But it’s not really about that, it’s about these men, mental health and their wellbeing."
