There is another simple explanation. It is an application of the placebo effect. When people believe strongly enough that a medication is effective, it will produce the relevant healing effect. Even though a tablet is actually chemically inert, it can heal in the right context. More importantly, the placebo effect amplifies the therapeutic effect of all real medications. So back to the question of why anyone should use acomplia.

The answer is in the great dependance on the precise effect that acomplia has. This medication is specifically designed to help people feel less hungry. Hunger is the psychological trigger to eating. Thus, if people feel only slightly hungry, they will naturally eat less leading to two opposing statements:

Acomplia should therefore not be seen as a weight reduction medication.

Both statements are true consequences. Acomplia is not in itself a “fat buster”. The active chemical ingredients do not circulate through the body via the blood stream metaphorically killing fat cells whenever they find them. It is only a psychological prop to help people maintain their motivation to diet. The body will lose weight naturally if people consume more energy than they take in. If people feel less hungry, this is easier to achieve. Now let us go back to the idea of a placebo making a drug more effective. If everyone believes that acomplia is a fat buster, then it is more likely that people will lose more weight using it.

Now to add one further reason for following the formula of acomplia + diet + exercise. It is suggested that acomplia is associated with mood changes. In this respect, the research published in the April edition of Br. J. Sports Med. makes interesting reading. It has always been intuitively obvious that regular physical activity helps to improve mood, although no-one has ever been able to suggest exactly how much of whatever activity achieves this effect. All researchers have said is that if the physical activity is affecting the body positively, the body releases dopamine to reinforce the sense of pleasure or enjoyment and so encourage more of the activity.

The study focussed on some 20,000 adult Scottish participants using the General Health Questionnaire. If there is regular activity, there is a clear reduction in the levels of psychological distress after adjusting for factors of age, gender, BMI, smoking, marital status, social economic group, and the presence of any chronic illness. Less frequent activity has an effect, but it is less significant. The strongest effect was obtained through engaging in a sport, but there were also good results from gardening and other hobby activities involving physical exercise. Even twenty minutes per week had a good effect on mood.

So, you must combine usage of acomplia with sport and diet. If acomplia does potentially have an adverse effect on mood, this may to some extent be relieved if you are also exercising regularly. This article is not, of course, suggesting that physical activity will be a guaranteed cure for any looming depression. But whether you exercise to lose weight or to improve your mood, acomplia with exercise is obviously going to be better than acomplia without exercise.

Acomplia should therefore be seen as a weight reduction medication.

Step aside “sleepwalking”. You have new competition.

Almost all those arrested say they have no memory of getting up or of driving. These are the “ambien drivers”. Now let us be clear. Ambien has not suddenly become unsafe. It has been on the market for thirteen years and there are few problems so long as people follow the manufacturer’s directions. But there were twenty-six million prescriptions written in the US last year, and more ambien was bought through online pharmacies. So we should not be surprised if a few people do habitual things when not quite awake.

If you look at the label on an ambien bottle or read the accompanying notes, you will see a clear warning that ambien can cause sleepwalking. The same effect is possible from alcohol so, in equally plain words, the label tells people not to mix alcohol and ambien. Wait a minute! Let us be cynical for a moment. Is this use of ambien a trick to create a defence to DUI? When involved in an accident, do drivers pop a quick ambien tablet into their mouths?

For once, this kind of behaviour seems unlikely. There is a pattern to the accidents where ambien is a factor. The drivers have failed to control the car in a spectacular way, e.g. by hitting parked cars or traffic signs on otherwise empty roads. They sit passively in the car after the accident. They make no response when approached by the police. At the March meeting of the American Academy of Forensic Science, a research paper reported cases of extreme driver impairment often with ambien either at overdose levels or mixed with other medications. This made the ambien sleep-driving explanation a plausible defence.

People affected by sleep disorders can act in unusual ways, particularly in the intermediate stage between sleep and being awake. If there is still some ambien active in the body, people do things around the house and have no memory of it the next day. It should not surprise us if, occasionally, this extends to driving. However, although forensic scientists have begun to talk more openly about the issue, it is still not possible to gauge the exact extent of the problem because only twenty-four states in the US routinely test blood samples from traffic accident cases.

Does this mean that ambien should have a stronger or more prominent warning label? At present, there is not enough evidence to suggest this is necessary. Although there are a few DUI cases involving ambien, there is no clear national pattern. The FDA has admitted to receiving forty-eight reports of adverse events arising from the use of ambien in 2004, but only one related to a traffic accident. Further, if there were so many ambien-related incidents, the news media would be full of stories and editorials demanding action. As it is, cases are noticed because they are still relatively unusual.

Why do these things happen? In some cases, it is almost certainly human nature. People forget the warnings, particularly about taking ambien after drinking alcohol, or they do not believe the warnings are serious. But a few people do find strange things happening to them. In 2001, the Mayo Clinic Sleep Disorders Center reported five cases where people had risen from their beds and eaten midnight snacks. But, so far, sleepwalking seems to affect only a tiny proportion of the millions of people who take ambien.

Nevertheless, I would feel more confident on the road if state and federal governments around the world did routinely test blood samples from everyone involved in traffic accidents. As more and more people take medications like ambien, whether for therapeutic or recreational purposes, I would like to know what the risk of being injured by a drug-impaired driver really is.

Second, we should critique the assumption that it is only the man in these relationships (who suffers from a lack of sexual ability) who must come to terms with what medical sociologist Kathy Charmaz calls “contingent personal identity, ” In the example above, note that the female partner is not assumed to have gone “flying out the door” in search of a capable lover when her husband was impotent. Overwhelmingly, the cost of erectile dysfunction to womenjin the relationship goes unexamined, unless it is coded within the frame of Viagra: a boon to a long passionless drought.ss And while cuddling is implied as the default substitute for impossible intercourse, no other forms of sexual play are considered in these articles. As Russell Watson’s Newsweek story “The Globe Is Gaga for Viagra” reminds us, “A poor lover plus Viagra does not make a good lover, but merely a poor lover with an erection.” Finally, despite the frequent use of the term “partner” - a descriptor that is used in the long - term committed relationships of both gay and straight couples - the articles quoted in this subsection refer exclusively tojheterosexual behavior, a tendency that will be examined more thoroughly tn the sub - section to follow.

Returning to the perpetuation of the mind/body split in the treatment of erectile dysfunction, the question must be asked - What is at stake Iwhen integrating the two (especially in a heterosexual model of relational tlynamics)? By acquiescing to an emergency room ideology of “treat ‘em and sfreet ‘em,” and accepting the biomedical solution to the putative sexual d1ysfunction within a relationship, the female partner enables the male partner to “save face,” but often at the expense of her own sexual needs and desines (or lack thereof). Within a relationship marked by traditional performances ofmasculine authority and feminine servility, it is the woman who feels the pressure to equalize the anxiety resulting from the compromised male ego. Writing about the experience of “first heterosex” (or perhaps, more colloquially, “losing virginity”), Janet Holland, Caroline Ramzanoglu, and Rachel Thomson suggest that it is through her participation in his performance [that] she is inducted to the world

of heterosexual sexuality, where she must learn to play by the masculine Irules of the game, or take the consequences of resistance …. Within this game, her sexual identity, subjectivity and desire are silent. To succeed as a woman, and to be rewarded, she must become proficient in supporting and satisfying masculine values and needs.

The woman’s complicity in the man’s performance is achieveb through silence. Her proficiency in supporting and satisfying his values (atid thereby demonstrating her success as a woman) is guaranteed by the biomedical endorsement and attributions of gender in the mind/body dualism. Something that “no pill will cure” is also subject to this gender Ґchotomy: none of the articles suggested that a man ordering Viagra might be concerned with intimacy dynamics.

The areas of relational communication I’ve addressed here ill’ustrate the ways in which Viagra’s benefits have been challenged by the popular press. The subtlety of taking a pill is an appealing antidote to the silence ind secrecy surrounding sexuality and its (presumed) impediments. Biomedicine’s embrace of pharmaceutical solutions reveals its advocacy of the mindybody split. The mind/body split not only fixes erectile dysfunction lin organic causes and normalizes the chemical solution, but also divides solutions along gendered lines, suggesting that men don’t require the cornmunidative therapy that women do. This divide has a profound affect on bothl individual partnerships and attitudes about gendered performances. These attitudes are discernible when men are quoted in these stories. Men in these articles - who speak anecdotally and metaphorically - reveal values and needs. Here I look at how masculine values and needs are portrayed in these news stories and how the masculine virtues of risk taking and sexual prowess are upheld.

First, the prerelease Viagra articles (September 1996-March 1998) outline the nature of erectile dysfunction with existing or proposed solutiolns driving the drama. Second, articles reporting on Viagra’s availability I appeared (March 1998-June 1998). These focus on the success of the clinical trials and the scientific clamor that accompanied the release. The third phase of articles emerged in the months following the unprecedented success of Viagra (June 1998-February 1999). These news stories focus I on three things: (1) the personal relationship aspects ofViagra; (2) the insu4ance controversies surrounding Viagra; and (3) the risks of Vi agra. The final stage of Viagra news takes us from a year after Viagra’s debut to the rdcent past (February 1999-0ctober 2002). These articles tend to focus on tije cultural implications of Viagra, particularly the scientific management of II’ male and female sexuality and its concomitant political economy.

Several components are emblematic of nearly every Viagra article. First, there are portraits of American males. These portraits reveal agd, occupations, values, and disappointments and successes. Second, there in personal (or lay) testimony-both by users and would-be users ofViagra-Jnd expert testimony by a variety of sexual- health professionals, including uro1ogists, primary care physicians, obstetricians and gynecologists, sex therapistsl and government officials. And third, there are statistics-statistics attesting to the preponderance of erectile dysfunction, the success rate ofViagra, add the cost ofViagra to insurance companies, and statistics establishing normative levels of a range of bodily systems.

Frequently in these news articles, Viagra is introduced through Ithe use of emphatic epithets. Eighteen months before its debut, Viagra was characterized as “the ultimate erection aid” in a Newsweek article by Geoffrey Cowley titled “Attention, Aging Men.”? Other cognomina for Pfizer’s capillary chemistry followed in quick succession. The New YOrk TimescalledlViagra “a wonder of the modern age,”3 “the new miracle drug,”4 and I”the new national drug of choice.”5 Newsweek followed with “the potency wonder drug,”> while U.S. News & World Report countered with “the sexual potency drug.”? Dorothy Nelkin, author of Selling Science) points out how descriptions like these both exaggerate the promise of new drugs and oversimplify the intricacies of chemistry to the bodyf Implied by the prevalence of these monikers is the idea that this technology is something we’ve all been waiting for.

regard toll communication and relationships reported in these news stories including (1) the silence between partners about ED; (2) the meaning of a biomedidl (rather than a communicative) solution; and (3) the need for relational repair that “no pill will cure.” An in’lportant motif has to do with the communication about erectile dysfunction that takes place and, perhaps more frequently, does not take place between couples. “I felt as if we were colleagues,” confides a man in an article in U.S. News & World Report. “We’d go places, we’d get done what needed td get done around the house, but there was this huge, dark subject we would1n’t discuss.”

Alon with fueling the stand - up routines for dozens of comedians, Douglas Ґartin’s New York Times article, “Thanks a Bunch Viagra; The Pill That Revived Sex, Or at Least Talking About It,” suggested that Viagra’s availability got people talking about sex generally and got men to visit their doctors.vi But once prescribed, couples were confronted with more than the capability I of (hetero )sexual expression. Jennifer Steinhauer of the New YOrk Times repbrts: When Ithe possibility of sex resurfaces, a couple is often at a loss. They never talked [much about their problems before, and now they have no idea how to approach the change. In the meantime, all the issues that contributed to the impotence or resulted from it have been long swept under the rug.

As Steinhkuer implies, impotence has both organic and psychological etiologies and Yiagra impacts both happy couples and unhappy couples. These

issues are] of course, related. Jane Brody, also of the New York Times, uncovers similaJ sentiments when she writes: Viagra does nothing per se to reawaken sexual desire and foster communication a4d loving feelings between loving partners who may have long ago put these aside. Men who are impotent often refrain from any physical or verbal expressions of tenderness and desire for fear of raising false hopes in their partners, ‘:tho may do lifewise to avoid inducing guilt in a man unable to perform sexually [my emphasise] The frequency with which “performance” is used to describe sexual health has been established as an ongoing theme in this website. Its use here points out the functional - c - or efficacious - definition of performance and provides an openidg for the ways in which performance is a presentation of self, a self sometimes compromised by a stigmatized condition. Regarding the performance of social stigma, Erving Coffman distinguishes passing from covering. “Passing” conceals a stigma from uhknowing persons while “covering” assuages concerns for those in the knowl or those he calls “the wise.” It would be difficult for a man to conceal his impotence from a partner with whom he has previously enjoyed sexual relations - that is, to pass. “Covering,” on the other hand, is a tactic requiring the !participation - whether active or passive - of both partners. Covering intimktes complicity of some kind. By representing erectile dysfunction as organic and developing a pill as the cure, biological sexologists are aligned with passing. Goffmtn writes, “[A] strategy of those who pass is to present the signs of their stigmatized failing as signs of another attribute, one that is less significantly a stigma. When erectile dysfunction can be attributed to an organic - or physiological - cause rather than a psychological or relational cause, three things happen simultaneously: (1) the ED sufferer situates the source of the problem outside of his ego and places it resolutely in his body; (2) the dreadbd visit to the physician lasts only as long as it takes to get a prescription fori Viagra;33 and (3) discussions with his partner concerning their romantic desires, differences, and difficulties can be avoided. At the risk of reinforcirlg stereotypes, I’d guess that these consequences would be pretty attractive tp the typical American baby boomer male. “[That] impotence is a problem of mechanics can be appealing,” writes John Leland in Newsweek. “It takes all the blame and guilt out of the equation. ” These media stories are clear in this conclusion: although Viagra may have people talking about sex, it doesn’t necessarily get couples talking about it. As long as impotence is attached to an organic etiology, couples are likely to avoid an interrogation of relational obstacles and obstructions. I I turn now to the second motif in this theme of communication between couples - the mind/body split in biomedicine.

LiterJry critic and philosopher Kenneth Burke suggests it is through “strategic I ambiguity” that the “debunker” combats opposing arguments (or, in this case, alternatives to Viagra) by discarding them overtly, only to advance the new argument covertly. His analogy) I think) is worth reproducing here: Matches may be used either to light our pipes or burn down our houses. And one can well understand why, if they were being used entirely for the purpose of burning down our houses, a thinker should arise to say: “Let us have no more matches.” By preventing the use, he [sic] could prevent the misuse. And then, if he still had occasion to light his pipe, he might make an altered recommeddation of this sort: “What we really need is lighters.” He might go on to show that matches are largely derived from tradition, whereas lighters are modern. And in our eagerness for the solution, we might be willing to meet the thinker ha1fway, failing thereby to note that lighters could be misused in quite the same Iway as matches were [emphasis original].2

So when we “light our pipes” with Viagra, as it were, rather ,than, for instance, a vacuum pump, we are thinking ofViagra as noninvasive (of both romance and the body). This is an ambiguous distinction at best linsofar as taking a pill is an act that has been rendered routine in this culture. The consequence of the myriad medicines we ingest unthinkingly is cause for concern. But Burke is suspicious of debunking generally. As he describes the process, the typical debunker constructs “a mode of argument that would, if carried out consistently, also knock the underpinnings from beneath his own

argument. ” Given the speed with which technology changes, it is no surprise that even Viagra (as Burke predicted) was being debunked by rival technologies.

John Leland of Newsweek points out: Others, though, are less sold on Viagra. Some doctors insist the future belongs to local medications, not a pill that circulates through the entire body. Ancj for all Viagra’s publicity, Pfizer’s research has not yet been through peer review. “They’ve presented the data in the most positive light,” says one top researcher, who is working on an alternative treatment [my emphasis] .

An impartial argument, then, questions the need to “correct” erbctile dysfunction (however defined) at all. The first theme in these news accounts is to sensationalize Viagra and to debunk the other, traditional therapies. This double strategy fails tq take into account the vast differences among these therapies regarding ease ?f acquisition, cost effectiveness, and most importantly, side effects. But the popularity of Viagra has also produced side effects of a different kind. Relational side effects often stem from the resurgence of (or potential for) sexual interest long since retired.

In a November 1997 Newsweek article titled “A Pill for Impotence,” John Leland writes, “Until recently, the only options would havq involved body-shop mechanics, either a surgical implant or a pump of the sort advertised in the back of men’s magazines.”18 In this example, the mpntion of body shops and men’s magazines gives an underworld if not “uriderclass” quality to a particularly sophisticated surgical procedure and a noninvasive, comparatively inexpensive, and successful mechanism. Each produces and sustains erections. By comparison, “Viagra is something very different,” writes Douglas Martin in a May 1998 article for the New York Timks, “much easier to use than previous generations of suppositories, injections) and vacuum pumps. “19 The appeal ofViagra is in its purported simplicity: just take a single pill and wait thirty minutes for an erection. No surgeons, no devices. Masculinity is maintained best by reducing the austere architecture to its bare

necessities. Look Ma, no hands.

In this example, from U.S. News & World Report) it is the patient (rather than the author of the story, the physician, or the pharmaceutical company) who rebuffs the use of surgical procedures or machinelike devices to restore his erectile function.

The doctor said [the patient] could try mechanical contrivances like a vacuum cuff of pump. Or he could have bendable rods surgically implanted. Or, using a small, !fine needle, he could inject alprostadil, a drug that mimics a natural substance! produced during sexual stimulation, into the penis, to encourage blood flow. [The patient] did not care for any of these options.I?

Is it any fonder men don’t enjoy going to the doctor? These other therapies “act” upon the would-be user. Moreover, in order to be effective, these remedies Imust exert force on the male body, as Jane Brody writes in the New YOrk Times, There II are half a dozen other effective remedies. But unlike the others, Viagra is a pill, ,making it a far simpler and more discreet remedy than its rivals, which indude drugs injected or inserted into the penis and devices implanted and injected [my ernphasisj.

Communication scholar Julia Wood points out how media influence both cultiliral images of gender and individual identities, controlling what we see and k60w, reproducing expectations, values, and ideals, and “pathologizing” the human body. She stresses how “one of the most damaging consequences dfmedia’s images of women and men is that these images encourage us to perceive normal bodies and normal physical functions as problems.”13 With regard to health issues in the media, health communication scholar Athena du Pre is suspicious of the tendency toward sensationalism, while encouraged by the ways in which media can increase the public’s awareness of health-rellated issues.Iv News agencies are quick to respond to stories that examine the medicalization of sexuality because, according to Leonore Tiefer, a scientific perspective legitimizes stories about sex.IS Medical news about sexlin the popular press satisfies the public’s craving for such news and simultaneously remains “clean” rather than pornographic.

As a group, the fifty-two news stories in my sample tell us a great deal about erectile dysfunction generally and Viagra’s impact on how men communicate lab out their bodies and sexuality specifically. Some are written with a great deal of social reflexivity-exposing assumptions made by physicians and therapists, questioning the ease with which Viagra order passed through the Food andl Drug Administration (FDA), and zeroing in on the relational fallout in a “make a pill” society. And yet, other aspects ofViagra’s impact remain unexamined, By examining these news stories-as a group-I locate agenealogy of fadors that produce, maintain, and (for some) transform assumptions of the sex4alized male body. I then interpret these assumptions, exposing the dorninanf discourse of biomedicine. Feminist political scientist Kathy Ferguson I suggests that it is through the lenses of interpretation and genealogy that the social critic can trace the “threads” of discourse. Genealogies not only imply multiple beginnings but also draw “attention to that which has been bmitted.”

The qontent of these articles touch upon five primary subject areas. Specifically, the media messages reveal assumptions and values about (1) pre-Viagra erectile dysfunction technology; (2) the impact ofViagra on romantic relationships; (3) testimonials of masculinity; (4) Viagra and death; and (5) the political economy of healthcare. The ordering of these themes is not indicative I of “most important” or “least important.” Rather, they are thoroughly interconnected and overlapping. I order them in this way in the interest of telling the story about Viagra as reported in our nation’s recognized news outlets and to suggest a genealogy of factors that maintain masculinity’s sexual sodialization. A discourse analysis of the Viagra story as reported in these news sources reveals the creation of a significant cultural narrative, thereby illuminating assumptions, ideals, and beliefs about sexJality and masculinity.