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Title: NEW APPROACHES TO impotence TX VARY WIDELY ,  By: Eastman, Peggy, Urology Times, 00939722, Feb99, Vol. 27, Issue 2

New oral agents, topical gels, and even surgical techniques are on the horizon

Bethesda, MD–The introduction of sildenafil citrate (Viagra) and the resulting public attention to erectile dysfunction have stimulated interest in other approaches to treating the condition.

That was certainly apparent at an NIH writers conference on impotence , where an international group of speakers reported on a wide range of new ED therapies, many of which are still considered investigational. Among the new treatments described:

More pills in development

Because sildenafil is ineffective in approximately 30% of patients and because its use is contraindicated in men taking nitrates, the door is open for additional oral therapies for ED, several presenters at the conference noted. Arnold Melman, MD, professor and chairman of urology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, cited three such alternatives being pushed toward the market:

• Apomorphine. This oral drug, now in phase III trials, will have “modest” success, predicted Dr. Melman. It has a 50 to 60% response rate.
• Phentolamine (Vasomax). Phentolamine, another oral agent, is also in phase III trials. Dr. Melman cited a study of 312 patients showing a “moderate” advantage of the drug over placebo in improving erections (Int J Impot Res 1998; [suppl. 3] 10:S61). To date, he said, studies do not indicate that phentolamine produces a marked improvement over sildenafil.

On the other hand, phentolamine does not interact with nitrates the way sildenafil does, thereby avoiding potentially dangerous drops in blood pressure. Phentolamine may thus be an option for patients taking nitrate drugs for cardiovascular disease, he said.

• Combination therapy. Dr. Melman said transurethral alprostadil (MUSE) combined with the alpha blocker prazosin hydrochloride (Minipress) and topical prostaglandin E1 may prove to be an effective treatment for ED. The combination of alprostadil and prazosin appears to work in some men who are unresponsive to transurethral alprostadil alone, he said.

While noting the importance of developing new agents for ED, Dr. Melman emphasized that the number of patients for whom sildenafil (or any other therapy) is appropriate and who are actually using the drug is still a small percentage of the treatable population. He said that approximately 15% of his patients do not use their prescriptions for sildenafil, and that he was “surprised at these low numbers.” He speculated that many of these men are interested in information only or are seeking to please their partners.

Dr. Melman is a consultant for Vivus, Inc., the manufacturer of transurethral alprostadil.

Preventing post-RP impotence

Francesco Montorsi, MD, professor of urology at the Divisione di Urologia, Instituto San Raffaele, Milan, Italy, said he was able to increase erectile function following nerve-sparing radical prostatectomy with a combination drug treatment.

Initially, though, Dr. Montorsi administered only intracavernosal injections of alprostadil, a vasodilator, soon after prostatectomy. He gave 5-mug injections of alprostadil twice weekly for 4 weeks.

“With this regimen, we were able to stimulate the circulation of blood and oxygen within the corpora cavernosa tissue and facilitate the recovery of spontaneous erections,” he said.

The approach improved erectile function in 70% of patients, but in an effort to boost the success rate even higher, Dr. Montorsi began adding sildenafil to the protocol. In a study of 25 patients who had undergone nerve-sparing radical prostatectomy, Dr. Montorsi found that 85% were able to obtain good erections with the combination of eight intracavernosal injections of alprostadil followed by sildenafil on demand.

“We now know that after nerve-sparing radical prostatectomy and a brief course of intracavernosal injections with the aid of [sildenafil], almost all men can retain their erectile potency,” said Dr. Montorsi. “If one considers that urinary continence is also maintained in the overwhelming majority of patients, we are now able to say the quality of life of these patients after surgery is no more a concern.”

He pointed out that a 100-mg dose of sildenafil was most effective in the study, though two patients responded well to 25 mg.

Penile ‘remodeling’

Surgical penile remodeling can be an effective treatment for impotent men whose erections are compromised by excessive penile length and low potency pressure gradient, said Dimitrios G. Hatzichristou, MD, PhD, professor of urology at Aristotle University, Thessaloniki, Greece.

By calculating the potency pressure gradient in a group of patients with ED, Dr. Hatzichristou was able to distinguish varying degrees of functional impairment. Five evaluated patients, for example, had normal hemodynamics and low diameter-to-length ratios.

“These patients were impotent due to unfavorable penile geometry,” he said.

Penile remodeling was performed in eight highly selected patients. The surgical technique was based on modified corporoplasty commonly used for correction of penile curvature.

“These techniques have been used successfully for a long period of time without any significant late complication, specifically in terms of their impact on erectile function,” said Dr. Hatzichristou. “It was thought that by applying this procedure bilaterally, it would be possible to decrease penile length and synchronously increase penile diameter.”

Dr. Hatzichristou said penile remodeling was successful in restoring erectile function in seven of the eight patients. Postoperative complications were “minimal” and were similar to those commonly seen in surgery for Peyronie’s disease.

“Larger series of patients and long-term follow-up are necessary to prove the efficacy of the newly proposed management strategy, further defining the subset of impotent patients that will be appropriately treated with the new therapy,” he said.

Topical therapies

New drug delivery systems combined with modern skin penetration enhancers make effective topical therapy for ED achievable, said Edgardo F. Becher, MD, PhD, associate professor of urology at the University of Buenos Aires, Argentina.

With the addition of skin penetration enhancers, “it is now possible to achieve an acute transfer of drugs to the corpus spongiosum and take advantage of its vast vascular communications to reach the corpus cavernosum,” he said.

Dr. Becher says the main advantages of local therapy for ED “are its safety and good tolerability in terms of local and systemic effects, and its ability to elicit a local response for diagnostic and therapeutic purposes.”

Thus, he said, even in the era of oral therapy, a safe, effective, easy-to-apply topical agent would have a place in the urologist’s ED armamentarium.

Dr. Becher noted that topical treatment for ED has been attempted previously with “very poor results,” using such substances as nitroglycerin, papaverine, minoxidil, and alprostadil.

“Most of the studies were done using a formulation without any skin penetration enhancer,” he said.

Dr. Becher investigated the effect of gels consisting of 0.2% and 0.4% alprostadil and a skin penetration enhancer in 52 patients with ED, yielding mixed results.

“Although there was a clear trend toward the active formulation, there was not astatistically significant difference with placebo for this small patient population,” he said. “However, in an open study using a formulation of 0.4% alprostadil and an enhancer, 0.5 grams of the gel produced a hemodynamic effect in the corpus cavernosum similar to that following intracavernosal injection and sexual stimulation as determined by duplex utrasonography.”

The results proved “that the drug penetrates the skin and reaches the corpus cavernosum in a concentration sufficient to cause smooth muscle relaxation,” he said.

Encouraged, Dr. Becher performed a female safety test in a study of 18 healthy volunteers using 1 gram of a gel with 0.4% alprostadil and an enhancer applied to the vaginal wall and introitus. All of the 10 postmenopausal and eight premenopausal women showed good tolerance to the gel, said Dr. Becher. One woman had minor bleeding of the cervix, and most had some minor skin irritation.

“All the patients showed labial and clitoral engorgement that was not referred to as uncomfortable, showing that the formulation is safe to be used for intercourse,” said Dr. Becher.

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By Peggy Eastman, UT Correspondent

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Source: Urology Times, Feb99, Vol. 27 Issue 2, p15, 3p

Title: HAPPINESS IS NOT FOUND ‘HAPPILY SKIPPING’ AT THE GUILD ,  By: Armstrong, Linda, New York Amsterdam News, 00287121, 10/25/2001, Vol. 92, Issue 43

A play without much substance or engaging characters is playing off-off-Broadway at the Hudson Guild Theatre. “Happily Skipping a Beat” is an attempt by Trinidadian native F.N. Asgarali to write a comedy/drama about what troubles a wealthy, middle-aged, white couple could have during their mid-life crises.

The husband, Egbert, is having problems becoming aroused, while his wife, Marla, is frustrated and unhappy. She is tired of being a conventional wife and mother and feels something is missing from her life.

The playwright, who is also the director, has the couple find satisfaction in the arms of others. While the play has humorous points, the funniest aspect is that Asgarali actually put it on a stage. The characters are superficial and too stereotypical, especially an underage Asian prostitute name Tinsie. She acts very silly and constantly mispronounces words or misunderstands their meaning.

Having sex with Tinsie ends up being Egbert s cure for impotence and the play ends with them under the sheets. Marla takes an African culture course with a young professor and opts for some extracurricular activity.

Throughout the play, the audience has to endure an overacted sex therapist, Dr. Rumple, played by Peter Galman.

After a couple of scenes from this play, one probably would decide they need to be somewhere else. This play is not worth the time. I encourage you to make sure your feet skip 26th Street.

Although a few snores could be heard in the audience during the performance, there were some bright spots. Byron Smith,John Squire and Molly Noe delivered entertaining performances.

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By Linda Armstrong, Special to the AmNews

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Source: New York Amsterdam News, 10/25/2001, Vol. 92 Issue 43, p34, 1p

Title: viagra ,  By: Goetzl, David, Advertising Age, 00018899, 06/28/99, Vol. 70, Issue 27

Section: The Marketing 100

DAVID BRINKLEY

David Brinkley says he was not surprised by viagra ’s blockbuster success, only by how quickly the drug became part of the cultural lexicon.

“I think the breadth of the media influence really surprised us,'’ says Mr. Brinkley, director-team leader of sexual health for Pfizer and architect of the drug’s marketing. “However, we define success on the patient level, and that didn’t surprise us.'’

viagra had an unparalleled impact on both fronts. The drug for erectile dysfunction became the most successful prescription drug launch, with $788 million in sales in its first nine months.

Despite a slowdown in sales after its initial success, viagra sales are still expected to reach $1 billion for 1999.

Under Mr. Brinkley, Pfizer successfully gave the problem of impotence a makeover by referring to it as E.D., or erectile dysfunction. The drugmaker had success destigmatizing the problem; it even persuaded former U.S. Sen. Bob Dole to appear in an ad for the subject this year.

“It’s not a character flaw,'’ says Mr. Brinkley. “It’s something that happens.'’

The viagra marketing effort began with a campaign directed at physicians and a consumer campaign followed.

At the same time, the drug’s introduction become a staple of TV and radio talk-show banter.

Mr. Brinkley says the the drug’s effectiveness for millions of men drives viagra sales more than any marketing technique or publicity buzz.

“All of our marketing work is not going to go anywhere unless you have a drug working for people,'’ he says. “The fact that it maintains a place in popular culture is due largely to that.'’

Now Mr. Brinkley is taking his U.S. launch experience on a global scale; he is in charge of overseeing the product’s launch in other countries.

PHOTO (COLOR): David Brinkley

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By David Goetzl

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Copyright of Advertising Age is the property of Crain Communications Inc. (MI) and its content may not be copied or e-mailed to multiple sites or posted to a listserv without the copyright holder`s express written permission. However, users may print, download, or e-mail articles for individual use.
Source: Advertising Age, 06/28/99, Vol. 70 Issue 27, ps34, 1p

Title: NATURAL DISASTERS ,  By: MILLMAN, CHRISTIAN, Men’s Health, 10544836, Apr99, Vol. 14, Issue 3

Section: remedies

Used wrongly, even the most effective weapons in the herbal arsenal can be dangerous

AMERICANS SPENT $5.1 billion on herbal supplements in 1997, and an estimated 12 percent of the population tried an herbal medicine. That’s up from 2.5 percent in 1990.

Because it’s herbs we’re talking about here, not prescription drugs, few journalists ask serious questions or press manufacturers for studies about the value and safety of their products, says Wallace I. Sampson, M.D., editor of the Scientific Review of Alternative Medicine. We hear about the anecdotal benefits, and sometimes we fall for the innocent-until-provedworthless logic peddled by herbal manufacturers: If you can’t prove the claim false, who’s to say it’s not true?

“You’d think the press would be the watchdog, the most cynical party,” says Dr. Sampson. “But they’ve been gullible in reporting on natural medicine.”

What’s more, the Food and Drug Administration doesn’t regulate herbs as it does prescription drugs, and it can’t require herbal manufacturers to prove that their supplements are effective.

That said, it’s important to note that some herbal remedies do appear to work, if they’re manufactured and taken correctly. Garlic may lower cholesterol, St.John’s-wort may relieve some kinds of depression, ginger can reduce motion sickness, and peppermint can ease an upset stomach. “But many people make a giant leap, saying that because some medicinal herbs work, all of them do,” says Stephen Barrett, M.D., of the National Council against Health Fraud, who operates the Quackwatch Web site (www.quackwatch.com). They don’t all work, and even some beneficial herbs don’t always live up to their reputations, especially if they’re misused or if the active ingredients aren’t standardized.

We’ve examined some of the most dangerous, ineffective, dubious, and misused herbs on the market. Some can kill; others merely waste your money. Here are the labels we’d like to see them carry.

Herb least likely to replace Viagra: yohimbe

Pausinystalia yohimbe is widely sold as a natural alternative for treating impotence . It’s thought that yohimbe can dilate blood vessels, increasing bloodflow to the penis. A recent review in the Journal of Urology of seven clinical trials including 419 impotent men found that a prescription version of the herb was more effective in producing erections than a placebo was. But over-the-counter preparations may carry some serious side effects, says Donald D. Hensrud, M.D., assistant professor of preventive medicine and nutrition at the Mayo Clinic.

First of all, yohimbe may react dangerously with a substance found in wine and cheese, causing high blood pressure, nausea, and vomiting. “It can also cause anxiety and sleeplessness, and even psychotic reactions in people who are predisposed to mental disorders,” says Dr. Hensrud. It’s better to shake the bed during sex, not after.

But chances are you won’t have to worry about any of that, because “there’s almost a 100 percent chance that the yohimbe product you purchase over the counter will be worthless,” says Varro Tyler, Ph.D., distinguished professor emeritus of pharmacognosy at Purdue University. An analysis of 26 commercial yohimbe products found that 17 contained insignificant amounts of the herb, or none at all.

Finally, it’s not smart to use yohimbe to self-treat sexual dysfunction. Even if it does work, its apparent ability to induce erections may be largely due to the placebo effect, which is notoriously strong where herbal remedies are concerned. And impotence can be a symptom of psychological problems or a serious undiagnosed disorder, such as diabetes or heart disease. See a doctor.

Herbal product most likely to be contaminated: zhong gan ling (and any herbal formulation imported from China)

Zhong gan ling is a combination of seven herbs (including Artemisia annua, shown here). It has long been used in China to treat cold and flu symptoms, and some health-food stores sell it in the United States, though it has never been proved effective. That’s not to say that it’s harmless. One woman in California who had taken zhong gan ling was admitted to a hospital with what appeared to be leukemia. Tests showed that the condition was caused by dipyrone, a veterinary ” painkiller not approved for use in the United States, which had been illegally added to the product. The FDA banned the import of this particular zhong gan ling product (which came from Meizhou City Pharmaceuticals in China), but others are still sold.

“We believe that contamination may exist among many imported herbs,” says Richard J. Ko, Pharm. D., Ph.D., a food and drug scientist for the California Department of Health Services. Ko recently tested 260 imported herbal medicines collected from California retail stores, and found that a third of them contained undeclared drugs or high amounts of toxic metals, such as lead, mercury, and arsenic.

“We’ve also seen some eases of contamination in Southeast Asian and Japanese supplements,” says Ko, “but most cases come from China.” Foreign manufacturers add these substancesto make their herbal remedies “work” faster and better, says Subhuti Dharmananda, Ph.D., director of the Institute of Traditional Medicine in Portland, Oregon. This con game is great for business, because people who use the herb testify that it works.

The smartest precaution is to avoid herbal products imported from China altogether. Check labels.

Herb most mistaken for a safe tranquilizer: kava-kava

Kava-kava (Piper methysticum), a member of the pepper family, has been touted recently as a safe, natural sedative–an herbal alternative to Valium. Pyrones, chemical compounds in the root extract, seem to act as muscle relaxants and often produce a sedating effect within 2 hours.

But you’d better not be driving on the interstate when the kava funk hits. Kava-kava depresses your central nervous system, and its side effects include loss of coordination, sluggish motor reflexes, and dilated pupils. (Sounds like a criteria sheet for the vice presidency.) One herb reference warns that kava-kava can increase the risk of suicide among depressed people.

If you feel that you need medication-herbal or other–to relieve anxiety, you need to see a doctor first. If your doctor gives you the nod, try kava-kava extract for 90 days, and consult the doctor a second time before opening another bottle. And never mix kava-kava with tranquilizers or other psychoactive drugs; the combination could make you foggier than Ted Kennedy in confession.

Most dangerous herb for aspirin takers: ginkgo

Ginkgo biloba, an extract taken from the leaves of the ginkgo tree, is a top seller, thanks to its reported ability to increase brainpower. Studies have found that it seems to sharpen memory and concentration in people with cognitive disorders, such as Alzheimer’s disease.

But ginkgo, according to Tyler, has one nasty and little-known side effect: It reduces the blood’s ability to clot. If people who take aspirin or other anticlotting drugs (often called “blood thinners”) begin taking Ginkgo biloba, the combination may cause internal bleeding in the brain, eyes, or other organs. As ginkgo’s use continues to rise, Ko says, physicians expect to see more such interactions.

“People don’t realize that if you’re using an herb, you’re using a chemical,” says Mary Ann O’Hara, M.D., of the University of Washington, author of a recent review of medicinal herbs. That chemical may react badly with other chemicals you’ve already put in your system.’

Most dangerous herb to eat: comfrey

Comfrey (Symphytum officinale) is sold as a topical gel, which you apply to minor cuts to fight infection and speed healing. It contains allantoin, a chemical that’s known to help skin repair itself. However, comfrey is also sold in tablets, teas, and herbal formulas that some people believe can treat stomach ulcers, though comfrey has never been shown to do a damn thing to fight ulcers. In fact, it contains toxic alkaloids that can destroy liver cells, and ingesting it can be dangerous. Some researchers believe that these alkaloids can be absorbed through the skin, and they recommend staying away from comfrey in any form. We’ll stick with Neosporin.

Herb most likely to be bogus: ginseng

Improved stamina, increased libido, less fatigue. What claim hasn’t been pinned on ginseng (Panax ginseng and Panax quinquefolius)? Everything or nothing may be true; most U.S. studies have yielded inconclusive results, and how ginseng works is unknown. But a few studies have suggested that ginseng may safely enhance mood. And Commission E, the agency that regulates herbal medicines in Germany, lists ginseng as a safe energy and memory stimulant. These factors have helped make it a topselling herb.

As with any popular herbal supplement, however, you have no way of knowing what’s in the bottle. “Quality control is one of the biggest problems in the herbal industry,” says Tyler. Because ginseng supplements are hot sellers and because genuine ginseng is expensive, this remedy, like ginkgo and St.-John’s-wort, is a favorite target of hucksters who sell bogus herbs. It’s an easy seam, since we have to trust herbal manufacturers that the bottle’s contents match the label. When experts have analyzed selected ginseng supplements, they’ve found that many contained few or no active ingredients.

To increase your chances of getting authentic ginseng, find a product that includes 100 to 125 mg of ginseng extract standardized to contain 4 percent to 7 percent ginsenosides (the key component of ginseng). If this is on the label, the odds are better that you’ve found a reputable manufacturer.

Dumbest herb to use as a quick pick-me-up: St.-John’s-wort

Studies have shown that St.-John’s-wort (Hypericum perforatum) can fight depression, possibly by affecting your brain’s levels of serotonin and other neurotransmitters. But for most people, this effect takes at least 6 weeks to kick in. Popping a St.-John’s-wort tablet on a gloomy day or drinking a $5 St.-John’s-wort concoction at some nouveau card is worthless. Any lift in mood will be the result of the placebo effect.

As with kava-kava, see a doctor before you take St.-John’s-wort to self-treat depression. If your doctor okays the herb, look for a product that contains a standardized dose (300 mg of 0.3 percent) of hypericin, the red pigment in the plant.

Most overpriced herbal painkiller: capsaicin

Most people know that chili peppers (capsicum plants) contain a substance called capsaicin. Like most muscle rubs, capsaicin causes a general irritation on your skin that produces a mild burning sensation and masks other pain. It may also block the transmission of pain signals to the brain. What’s puzzling is that so many people gladly pay $5 for a tube of capsaicin “sports balm.” Do this: Invest 50 cents in a hot pepper, break it open, and rub the inside on your sore muscles. (Test a small area first, so you know you won’t develop a skin reaction, and don’t rub your eyes or touch your face till you’ve washed your hands thoroughly.) Bet it gives you the same relief as the brand-name stuff. You can mix pepper shavings into an inexpensive hand lotion, too.

Weight-loss herb most likely to kill you: ephedra

Also known as ma huang, ephedra is used in several weight-loss concoctions, including “herbal phen-fen.” It contains ephedrine, a stimulant, which leads some people to believe that it spurs weight loss. It’s also sold as an asthma treatment, and it contains pseudoephedrine, a decongestant. Ephedra’s popularity as a weight-loss aid and a recreational drug has reportedly caused medical problems in at least 800 people and at least a dozen deaths.

The problem is that it’s difficult to tell how much active ingredient is in a particular batch of ephedra, because growing conditions vary the potency. Ephedra also has “a narrow therapeutic window,” according to Dr. O’Hara. Too little does nothing. Too much can raise your blood pressure and heart rate to potentially fatal levels. Long-term users have also become dependent on it. Steer clear.

Herb most likely to be used the wrong way: echinacea

Echinacea is known as the cold-fighting herb. (Three speciesare available in the United States.) Taking 250 mg, standardized to contain 4 percent echinoside, every 6 hours for 2 days can help you shake cold symptoms faster, says Tyler.

People misuse echinacea in one of two ways. Some hypochondriacs drink a few tinctures and suck on a few lozenges every day, thinking they’ll fend off colds. That’s a waste of money (and taking echinacea for more than 2 months at a time may cause immune-system problems). A study of 302 people found that echinacea was no better than a placebo at preventing colds. Other people take echinacea only when they’re hacking like an ER extra. The rhinovirus is well established by then, and echinacea will be less effective. “You have to take it at the first sign of a cold,” says Tyler. If you wait more than 3 days, it’s probably too late.

Weeding Out the Bad Hebs

Follow these anti-B.S, guidelines when sizing up an herbal remedy

1. Question the studies. If the advertisements tout studies, call the company and ask to see them. If the maker won’t release them, or if they weren’t placebo-controlled, doubleblind studiesthe results aren’t reliable.
2. Watch for hype words. Any herbal remedy that’s marketed as a “medical breakthrough,” “secret formula,” “amazing discovery,” or “fountain of youth” is probably worthless. Breakthroughs take years to break through (Viagra began its journey back in 1990), and many secrets are kept in order to escape scrutiny.
3. Ignore testimonials. “The placebo effect is responsible for about 30 percent of improved symptoms in studies,” says Donald D. Hensrud, M.D., of the Mayo Clinic. The power of suggestion is especially strong with herbs, since most promise subjective benefits, such as increased energy. “It worked for me” endorsements are worthless, except to the person who was paid to make them.
4. Don’t buy the “used for thousands of years” line. Pill marketers often cite the ancient healing traditions of faraway lands. Where have these herbs been used? India, where people live to be 62.9? China, where they see 69.6 years on average? These countries rely on herbs much more than the United States–where life expectancy is 76.1. There are countries, Such as Germany, where herbal remedies are more mainstream than here and where life expectancies are higher, so this is not a blanket condemnation of medicinal herbs. Just don’t fall for the “wisdom of the ancients.”
5. Clear it with your doctor. Call and ask if there’s any danger in taking the herbal remedy. Remind the doctor of the other drugs you take, both prescription and over-the-counter. Then double-check with the pharmacist. It’s worth a few questions to dodge liver failure.

PHOTO (COLOR): YOHIMBEE

PHOTO (COLOR): ARTEMISIA

PHOTO (COLOR): KAVA-KAVA

PHOTO (COLOR): GINKGO BILOBA

PHOTO (COLOR): COMFREY

PHOTO (COLOR): GINSENG

PHOTO (COLOR): ST-JOHN’S-WORT

PHOTO (COLOR): CAPSICUM

PHOTO (COLOR): EPHEDRA

PHOTO (COLOR): ECHINACEA

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By CHRISTIAN MILLMAN

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Copyright of Men’s Health is the property of Rodale Inc. and its content may not be copied or e-mailed to multiple sites or posted to a listserv without the copyright holder`s express written permission. However, users may print, download, or e-mail articles for individual use.
Source: Men’s Health, Apr99, Vol. 14 Issue 3, p90, 4p

Title: PHYSIOLOGICAL MECHANISMS OF SEXUAL DYSFUNCTION SIDE EFFECTS ASSOCIATED WITH ANTIDEPRESSANT MEDICATION ,  By: Murray, John B., Journal of Psychology, 00223980, Jul98, Vol. 132, Issue 4

ABSTRACT. Sexual dysfunction side effects have been associated with antidepressant medication, especially with serotonin reuptake inhibitors. Neurotransmitters appear to be involved, especially dopamine and serotonin, but the processes by which they influence sexual dysfunction are not clear.

THE EFFECTS OF PSYCHOTROPIC MEDICATIONS on human sexual functioning have been recognized for years. Such effects are now receiving even more attention because antidepressant medications, especially the selective serotonin reuptake inhibitor (SSRI) agents, have been accompanied by greater incidence of sexual side effects than has been expected, based on data from prerelease studies (Gitlin, 1994; Greenberg, 1971; Herman et al., 1990; Kline, 1989; Monteiro, Noshirvani, Marks, & Lelliott, 1987; Patterson, 1993; Singh, 1961; Zajecka, Fawcett, Schaff, Jeffriess, & Guy, 1991).

Many case reports and results of a few controlled studies have documented the associations among sexual dysfunction side effects and all classes of psychotropic medications–neuroleptics, benzodiazepines, and antidepressants (Akhtar & Thomson, 1980; Cohen & Rosenbaum, 1987; Decastro, 1985; Ghadirian, Annable, & Belanger, 1992; Ghadirian, Chouinard, & Annable, 1982; Jani, Wise, Kass, & Sessler, 1988; Lesko, Stotland, & Segraves, 1982; Lydiard, Howell, Laraia, & Ballenger, 1987; Sangal, 1985; Segraves, 1992; Wesson, Finnegan, & Clark, 1996). The physiological mechanisms involved in sexual dysfunction side effects are the topic of the present report. Systematic studies are lacking, and most of the reports are based on small samples of research participants.

Sexual dysfunction side effects are important clinically because they contribute to noncompliance with treatment regimens and may impair the user’s quality of life (Balon, Yeragani, Pohl, & Ramesh, 1993; Greenberg, 1971; Rothschild, 1995). For this reason, clinicians are advised to ask patients, particularly those taking SSRI medications, about sexual side effects; clinicians should not depend on patients’ spontaneous admissions. Patients are apt to put aside the medications that disturb them. Women may be less likely than men to spontaneously report sexual side effects. More research with female patients is needed, but reports that have stratified results by sex indicate that sexual side effects are comparable for men and women (Gitlin, 1994; Monteiro et al., 1987).

Estimates of the incidence of sexual dysfunction side effects associated with SSRIs range from 9% to 24% of users. Patients’ self-reports suggest that delayed or absent orgasm or ejaculation occurs in 11% to 20% of patients taking Prozac (fluoxetine), one of the most popular SSRI antidepressants (Segraves, 1994). Balon et al. (1993), using a questionnaire that focused on sexual side effects, found that 43% of their patients experienced sexual and other side effects associated with a variety of psychotropic medications. Patterson (1993) asked 60 male patients (average age 35 years) who were taking fluoxetine whether they experienced sexual side effects, and 45 (75%) reported retarded ejaculation or ejaculatory incompetence. Reducing the drug schedule to every other day reduced sexual dysfunction side effects for 50% of those patients.

Of 103 bipolar depression patients receiving lithium alone or in combination with other drugs, 75% of the women and 58% of the men indicated no change in sexual function, according to self-reports (Ghadirian et al., 1982). But lithium has been found to have fewer sexual dysfunction side effects than other antidepressant agents (Gitlin, 1994).

Can patients get relief from the sexual dysfunction side effects of antidepressants? Results of studies with a limited number of patients have indicated that sexual dysfunction side effects can be reduced (Gitlin, 1994, 1995). Strategies used to treat SSRI-induced sexual dysfunction include adding other medications, such as cyproheptadine (an antihistaminic/antiserotonergic agent; Decastro, 1985; Feder, 1991; Goldbloom & Kennedy, 1991; Katz & Rosenthal, 1994; McCormick, Olin, & Brotman, 1990; Segraves, 1987). Yohimbine, an adrenoceptor blocker, improved sexual function in a few patients who had received fluoxetine (Hollander & McCarley, 1992; Jacobsen, 1992; Pollack & Hammerness, 1993), as did amantadine, a mild dopamine agonist (Balogh, Hendricks, & Kang, 1992). Delaying medications until after coitus or taking yohimbine or cyproheptadine about 2 hr before engaging in sexual activity may restore ejaculatory function (Decastro, 1985; Segraves, 1994). Taking a reduced dosage and brief drug holidays have improved sexual functioning in a few patients (Rothschild, 1995). Switching to bupropion of the aminoketone class of antidepressants led to improvement in sexual function for some patients who had received fluoxetine (Jefferson, 1995; Walker et al., 1993). Double-blind studies are needed to establish the most effective treatments for reducing/preventing sexual side effects associated with SSRI antidepressants (Gitlin, 1994).

Sexual dysfunction can be divided into three categories: (a) loss of sexual interest or libido; (b) loss of physical arousal, including lubrication in women and erectile function in men; and (c) loss of orgasm, including ejaculation in men. Sexual dysfunction in all three areas has been associated with the three most commonly prescribed psychotropic medications (antidepressants, benzodiazepine, and neuroleptics; Gitlin, 1994). Because the erectile function is easier to observe, many studies have focused exclusively on men. When sexual dysfunction side effects of SSRI medications are cited, the three categories are not always included. Priapism, a pathologically prolonged and painful penile erection (a rare but serious effect of psychotropic medications), has been helped by injection of an alpha-adrenoreceptor stimulating drug, but the condition may require surgery (Kogeorgos & de Alwis, 1986; Patt, 1985; Raskin, 1985).

Patients with bipolar disorder who take lithium alone or in combination with other drugs identified decrease in sexual desire as the greatest difficulty (43% of the men and 40% of the women), followed by decreased quality of orgasm (24% of the women and 36% of the men; Ghadirian et al., 1992). Men reported delayed and absent ejaculation as problems associated with lithium in combination with other medications. The medications used in combination with lithium appear to be more of a factor in sexual dysfunction than is lithium used alone.

Mechanisms Possibly Involved in Sexual Side Effects

The incidence of sexual side effects associated with antidepressant medications, particularly the SSRI class, has been higher than expected from data in prerelease tests. Moreover, sexual side effects can arise from many sources.

Physiological mechanisms involved in psychotropic medications’ association with sexual function are not clearly understood (Ghadirian et al., 1992). SSRI antidepressants enhance serotonergic neurotransmission through selective inhibition of presynaptic neuron reuptake of serotonin (Benfield, Heel, & Lewis, 1986). The therapeutic efficacy of SSRIs is comparable to the older tricyclic and monoamine oxidase inhibitor (MAOI) antidepressants, and they have fewer side effects. Nonetheless, clinicians must carefully monitor patients’ reactions to the drugs because of the known sexual dysfunction side effects (Sussman, 1994).

All the antidepressants share a common adaptive regulation of noradrenergic, serotonergic, and glutamate neurotransmission, suggesting possibly unifying mechanisms of action underlying their antidepressant effects (Kilts, 1994). A new antidepressant, nefazodone, has a twofold pharmacologic action on the serotonergic system and appears not to cause sexual side effects (Feiger, Kiev, Shrivastava, Wisselink, & Wilcox, 1996; Goodwin, 1996; Robinson et al., 1966; Taylor et al., 1995).

Sexual dysfunction could come from nonspecific central nervous system effects such as sedation, which can lead to a general decrease in sexual interest and function. Medications that block neurotransmitters such as serotonin and dopamine could cause sexual arousal and/or sexual dysfunction (Crews, Paul, & Goodwin, 1981; Goodwin, 1996; Segraves, 1989). Some medications have multiple effects that lead to complex clinical effects; SSRI and tricyclic antidepressants may interact antagonistically (DeVane, 1994; Goldbloom & Kennedy, 1991; Goodnick, 1989; Hyman & Nestler, 1996; Kapur & Remington, 1996; Katz & Rosenthal, 1994; Popli, Baldessarini, & Cole, 1994; Preskorn, 1996; Robinson et al., 1996; Service, 1996). Because sexual dysfunction can come from many sources, clinicians are urged to examine patients thoroughly before attributing the dysfunction to antidepressants (Gitlin, 1994).

The biology of normal sexual response and activity is not completely understood (Gartrell, 1986; Gitlin, 1994; Segraves, 1989). Consistent data on age-related reduction of sexual desire in the general population are lacking; baselines of sexual function in patient populations before treatment are rarely described, and the effects of Axis I disorders on sexual functioning are not often reported (Feiger et al., 1996; Goodnick, Henry, & Buki, 1995; Weizman et al., 1983). Decreased sexual interest during depressive illness has been considered so common that it once was a diagnostic criterion of depression.

With depressed patients, factors separate from the impact of psychotropic medications on sexual dysfunction, such as the effects of substance abuse, alcohol, and opiates, should be investigated (Cushman, 1972; Schiavi, Stimmel, Mandeli, & White, 1995). Studies have demonstrated differences in neuroendocrine responses of depressed and healthy control groups (Goodnick et al., 1995; Pearlstein & Stone, 1994; Price, Charney, Delgado, & Heninger, 1991; Schwartz, Bauman, & Masters, 1982).

The action of neurotransmitters has been used to explain human behavior, both normal and abnormal. Neurotransmitters have been associated with effects on peripheral behavior as well as central functions. Peripheral a-adrenergic blockade may cause prolonged erection, and medications with a-blocking properties promote erections (Gitlin, 1994). Ejaculation seems to be peripherally mediated by a-adrenergic blocking properties (Jacobsen, 1992; Mendels, 1995; Wise, 1994). The relative effects of excitatory and inhibitory neurotransmitters may result in enhancement or inhibition of sexual functioning (Segraves, 1989). Trazodone, a SSRI class medication, has increased libido in a few patients; in a few others, it led to orgasmic inhibition (Gartrell, 1986; Jani et al., 1988; Sullivan, 1988).

Single neurotransmitters may be altered by medications, but several neurotransmitters, such as norepinephrine and serotonin, are viewed as altered by the same antidepressant (Goodnick et al., 1995; Taylor et al., 1995). Neurotransmitters may interact as serotonin and dopamine seem to do, but serotonergic modulation of dopaminergic function is not yet well understood (Hyman & Nestler, 1996; Kapur & Remington, 1996). SSRI drugs may potentiate inhibitory effects of serotonin on metabolic production or on release of dopamine by neurons of the basal ganglia (Baldessarini & Marsh, 1990). Serotonin may have an inhibitory action on dopamine neurons of the midbrain and brain stem. Fluoxetine has been shown to inhibit synthesis of catecholamines in several dopamine-rich areas of the forebrain. Results with amantadine, a mild dopamine agonist, suggest that anorgasmia may be traced to the effects of serotonin on dopamine activity (Balon et al., 1993; Stark & Hardison, 1985).

Sexual side effects with neuroleptic drugs probably can be traced to the dopamine-blocking properties of those drugs (Segraves, 1989). Dopamine agonists may improve libido (Gitlin, 1994). The neurotransmitter acetylcholine probably does not play a direct role in sexual function, but it may have a mediating, indirect effect. Anticholinergic side effects are not prominent with SSRI antidepressants (Balon et al., 1993; Stark & Hardison, 1985).

Because SSRI antidepressants have been associated with many sexual dysfunction side effects, sexual dysfunction appears to be related to serotonin; however, how serotonin influences sexual function is not yet clearly understood (Dubovsky & Thomas, 1995; Gitlin, 1994; Price et al., 1991; Robinson et al., 1996; Spoont, 1992; Sussman, 1994; Walker et al., 1993). Serotonin was isolated from whole blood less than 50 years ago and recognized as a vasoconstrictor. For almost 10 years, drugs that selectively act on reuptake on serotonergic nerve terminals have been effective antidepressants (Goodwin, 1996). The SSRIs are more effective than placebos in major depression and equal in efficacy to older antidepressants. Clinically consistent evidence has shown, however, that SSRIs and the drug clomipramine are associated with high rates of decreased libido, erectile dysfunction, ejaculatory disturbance, and delayed orgasm and anorgasmia. Research with animals has offered no clear picture of the connection between serotonin and sexual dysfunction side effects (Adler-Graschinsky, Butta, & Elgoyhen, 1986; Gitlin, 1994; Segraves, 1989; Zitrin, Beach, Barchas, & Dement, 1970).

Virtually all antidepressants have been reported to occasionally decrease libido, cause delay of orgasm and anorgasmia, and cause erectile dysfunction (Gitlin, 1994). Fluoxetine dominates the market, so sexual dysfunction side effects associated with it have been reported frequently. Other SSRIs, such as sertraline and paroxetine, also appear to be associated with those sexual dysfunction side effects (DeVane, 1994; Feiger et al., 1996; Stark & Hardison, 1985; Wernicke, 1985). Fluoxetine may exert indirect pharmacodynamic action on nonserotonin systems of the brain and may be involved in potentially clinically important pharmacokinetic interactions with other agents (Baldessarini & Marsh, 1990). Antidepressants such as nefazodone, which affects more than one serotonin nerve terminal and has not been associated with sexual dysfunction, would benefit depressive patients and spare them the burden of sexual side effects; consequently, they might not be tempted to discontinue use of their antidepressant medications.

Discussion

Sexual dysfunction side effects associated with antidepressants, especially the SSRI agents, have embarrassed patients and disturbed them enough that some have discontinued taking their medications. Antidepressant medications have benefited many depressed patients since their introduction 40 years ago; most patients receiving them apparently do not experience sexual dysfunction side effects. However, the incidence of sexual dysfunction side effects associated with antidepressants may have been underestimated; the incidence of reported problems has been greater when patients have been questioned about side effects than when researchers have relied on spontaneous reports of difficulties. Women are less likely to report sexual dysfunction spontaneously; however, because sexual dysfunction may be traced to disturbed endocrines (for example, in diabetes mellitus), more information about women is needed. Studies on sexual dysfunction side effects mostly have been based on small numbers and have lacked controls, although recent investigations have been multicentered.

All antidepressants have approximately equal clinical efficacy and modulate a number of different nerve receptors after chronic administration. All have a delay in onset of action. Such commonalities suggest a receptor theory of antidepressants, but whether the abnormality in receptor function is a necessary and sufficient cause of abnormal affect states is not known.

SSRIs have proved to be important therapeutic agents for depression, and they have been effective in treatment of obsessive compulsive disorders and panic disorder. A new antidepressantmay be the drug of the future because it is therapeutically as effective as the older tricyclics (MAOIs and SSRIs) but has not been associated with sexual dysfunction side effects.

Animal studies have not clarified the action of serotonin in sexual function. Some evidence indicates that dopamine and serotonin are involved together in several sexual dysfunctions. Alpha-adrenoreceptors probably also play a role.

Sexual dysfunction varies and has been associated with benzodiazepine and neuroleptics, but it has been more frequently associated with antidepressants. Sexual dysfunction also has been associated with substance abuse and some medical conditions involving endocrines. Thorough examination of depressive patients’ backgrounds is urged in order to eliminate other sources of sexual dysfunction before changing their psychotropic regimen. Pharmacology has extended the number of serotonin receptor subtypes, and the challenge remains to develop antidepressants that target specific receptors that will help depressed patients without burdening them with sexual dysfunction.

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Received November 7, 1996

Address correspondence to John B. Murray, St. John’s University, Psychology Department, 8000 Utopia Parkway, Jamaica, NY 11439.

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By JOHN B. MURRAY, Psychology Department St. John’s University

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Source: Journal of Psychology, Jul98, Vol. 132 Issue 4, p407, 10p

Title: VIAGRA MAY STILL BE MOSTLY A GUY THING ,  By: Kalb, Claudia, Newsweek, 00289604, 11/15/99, Vol. 134, Issue 20

Section: BUSINESS

Viagra’s got a pretty solid record when it comes to performance in men. But will it work for women, too? Some swear by it, and a small pilot study of women has found that the drug can boost sexual response significantly. But the reality for big populations may be less promising. NEWSWEEK has learned that in the first large-scale clinical trial involving women, Viagra does not appear to work miracles. Dr. Raymond Rosen, a Pfizer consultant, told researchers at a medical conference at Boston University last month that the data is “not going to show broad or robust effects” in females. Later, Rosen told NEWSWEEK his comments were based on informal feedback from investigators. Pfizer wouldn’t comment on the trial results, which they plan to release at a scientific meeting next year.

Pfizer’s study included 800 pre- and postmenopausal women in Europe who suffered from sexual dysfunction, which can mean anything from lack of libido to difficulties with arousal or orgasm. Future studies could refine the trial by excluding women whose problems stem from emotional or relationship issues (not exactly fixable with a pill) and targeting women who have specific physiological conditions. Rosen, codirector of the Robert Wood Johnson Medical School’s Center for Sexual and Marital Health, says researchers are already studying Viagra in women with spinal-cord injuries, diabetes and uterine cancer. Anecdotal evidence suggests that women who’ve had hysterectomies or are on certain antidepressants (which can dampen sexual response) may also benefit. Viagra could still offer hope for women eventually–just not as obviously as it does for men.

PHOTO (COLOR): Blue is for boys: No miracles for women

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By Claudia Kalb

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Source: Newsweek, 11/15/99, Vol. 134 Issue 20, p66, 1p

Title: A RISE IN DEMAND ,  By: Sparks, Debra, Financial World, 00152064, 01/21/97, Vol. 166, Issue 1

Section: Market Watch

There’s about to be a second sexual revolution.

Not since the birth control pill hit 30 years ago has a slate of new drugsbeen set to make such a commotion. Says Dr. Irwin Goldstein, professor of urology at the Boston University School of Medicine: “We have to put second locks on the doors where we have our medication. People have broken into the sites where we do research.”

What’s going on? Is this some new aphrodisiac in a bottle? Well, almost. Dr. Goldstein is referring to a medication developed by Pfizer currently undergoing Food and Drug Administration clinical studies to treat erectile dysfunction–better known as impotence.

Impotence is an issue that’s about to come out of the closet big time. Says Dr. Fran Kaiser, a professor of medicine and director of the sexual dysfunction unit at St. Louis University: “Aging yuppies are not going to take not having sex lying down. They are demanding product availability.”

Are erections that much of a problem? Apparently so. According to a widely quoted study, which appeared in the Journal of Urology in 1994, 52% of men between the ages of 40 and 70 report some form of impotence. More specifically, 10% reported complete impotency, 25% had moderate symptoms and 17% had minimal impotency.

Dr. Goldstein says that only 7% of people with this problem seek treatment each year, a total of about 2.5 million men. London-based J.P. Morgan analyst Mark Becker estimates that 70 million men will make up this market worldwide by 2000.

Regardless of the statistics one uses, it appears, at least to doctors, that the number of men seeking treatment for this problem is definitely growing. Dr. David Kaufman, a urologist in New York City, says erectile dysfunction has become a very big part of his practice. “I get 20 new patients a week with this problem.”

The first major splash in this industry came when Pharmacia & Upjohn introduced Caverject earlier this year. Caverject is a disposable needle containing alprostadil. Injected into the penis, the drug increases blood flow. Caverject is expected to bring in $75 million in revenues this year.

Before Caverject, injection therapy was available only from urologists, who mixed the drugs themselves in their offices. About 500,000 men seek this treatment each year, but 50% of those drop out within a year. While the treatment is considered to be very effective, “it’s difficult for a man to stick a needle in his favorite part of his body,” says Dr. Kaiser. Another downside is that injections can cause scarring.

From an investment standpoint, Pharmacia & Upjohn is obviously no pure play. Although a $75 million-in-revenue product, Caverject represents a tiny portion of Pharmacia & Upjohn’s $7 billion in revenues.

Of course, any man suffering from impotence would probably prefer to take a pill anyway and be done with it. Pfizer is hoping that its viagra will be that magic bullet. Currently under Phase II clinical studies, this is the drug that Dr. Goldstein has to keep under lock and key. Pfizer is expecting it to be a blockbuster, multibillion-dollar product.

But viagra clinical studies must be especially rigorous since the drug is given orally and can affect other functions in the body. In its initial viagra studies, Pfizer has already found side effects related to the nervous system.

Even if all testing goes well and FDA approval is granted, the earliest the drug would be made available is probably 1999. And since Pfizer is also a large company, with $10 billion in revenues, there’s no big potential pure play here either.

Admittedly not as palatable as a pill, but certainly easier to take than a needle, is a new impotence product called Muse, which consists of a patented small plastic applicator that inserts alprostadil into the urethra. With the pill still a few years from the market, Muse’s maker, Vivus, currently seems like the best investment for this market.

According to Dr. Kaiser, one of the doctors who oversaw clinical trials for Muse, “As soon as the news hit that Muse got FDA approval [in November], we received a spate of phone calls.”

Vivus, a Menlo Park, Calif.-based company that specializes in drugs for erectile dysfunction, just started rolling out Muse, its first commercially available product, in mid-December. Its stock is at 31 3/8, in the middle of its 52-week range of 23 to 42. Wole Fayemi, an analyst at Genesis Merchant Group in San Francisco, thinks the stock could double, to 60, within 12 months.

He predicts that Vivus, which currently has negligible revenues and loses money, will see $450 million in revenues and earnings of $4.25 a share by 2000. Those numbers are based on the conservative assumption that the figure of 2.5 million men seeking treatment does not grow.

“There are probably 15 million men at present in the U.S. with this problem who don’t go to a doctor,” says Fayemi. “With increased advertising because of the Upjohn product and a new noninvasive way of treating patients, how many of those 15 million could show up in the office?”

Even if Pfizer’s viagra pill becomes available in the next few years, Fayemi says there’s still room for growth in the market for all these treatments.

Says Larry Feinberg of Oracle Partners, a health care-oriented hedge fund based in New York City that owns Virus shares: “A few cocktails and a few Muses will be the way of the future. They’ll replace peanuts at the bar.”

Yuck, yuck.

~~~~~~~~

By Debra Sparks

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Source: Financial World, 01/21/97, Vol. 166 Issue 1, p16, 2p

Title: SEX LIES AND AUDIOTAPE ,  By: Swartz, Mimi, Texas Monthly, 01487736, Jul93, Vol. 21, Issue 7

YEARS AFTER HIS LAST BIG HIT, KENNY ROGERS FINDS HIMSELF ENTANGLED IN A TAWDRY PHONE-SEX SCANDAL. IS THE HOUSTON-BORN SINGER SELF-DESTRUCTING –OR IS HE THE VICTIM OF A CELEBRITY SHAKEDOWN?

EVER SINCE LAST FALL,KENNY Rogers’ private life has been a public hell. Before that time, he had quietly, if not entirely willingly, assumed aging star status, coasting on his hits of the late seventies and early eightiesthat of a warm, loving family man who is, in the words of old friend and songwriter Mickey Newbury, “a threat to no man’s wife and no man’s daughter.”

But then three women from the Dallas-Fort Worth areaa reference to his folksy, friendly, paternal public persona.

In Kenny Rogers’ sexual fantasies, that persona appears infrequently. Instead, there is the masseuse, who arrives at another woman’s hotel room with a bottle of ejaculate disguised as a bottle of massage oil. “You’re in, uh, Mexico. A place you’ve never been before,” begins the unmistakable but slightly more aroused voice that cut “Through the Years.” “She takes you in and lays you down on this bed on your stomach, and she starts putting hot oils [on you]…. She separates your legs and starts rubbing your legs and it feels so good….” There is the intruder in the ski mask who likes to tease his victim with his enormous member: “He’s a big guy, six foot three maybe, but a great body…. He’s been in the sun, you can tell…. He’s so gentle with you and he takes his pants off end he’s got on these underwear that are kind of silk underwear… and you feel his skin all over you….” Then there is Rogers himself, who, in an imaginary hotel room, has taken a shower and put on a robe: “I kiss all over your face and I kiss your ears, kiss your neck, and I climb down and kiss your arms and I ask you to put your arms above your head and I kiss all down the inside of your arms….”

In the fantasies, certain NC-17 words, referencing male sexual organs, female sexual organs, and what they do together, are repeated frequently. Certain themes are repeated as well. “This guy is preoccupied with tans and rain,” insists Gary Richardson, the plaintiffs’ attorney who can recite passages from the tapes verbatim, though they lose something when his outraged yips replace Rogers’ husky growl. It is not surprising that Richardson calls the tapes “sick” or that the tabloid TV show A Current Affair, which broadcast selections from them, would label them evidence of Rogers’ “dark obsession.” Nor is it surprising that, after the lawsuit was filed, the Star would take the opportunity to brand Rogers a “sex pest.” For a guy who once closed his concerts with slide shows of his wife and child. this is pretty hot stuff.

Only Kenny Rogers gives himself mediocre reviews. “It’s not like I took fourteen-year-old girls and tied them up and fed them drugs,” he declares. “I mean, these were conversations. These were words. You can go to any movie and hear this.” He’s right: The tapes may not be as imaginative as Vox, the best-selling novel about phone sex, but they are devoid of the gratuitous sexual sadism that is so avidly promoted on MTV. The tapes contain lots about lingerie and thunderstorms and nothing about bestiality and bondage. As fantasies go, they are, like Rogers’ music, middle of the road.

In Rogers’ mind, and in the minds of most everyone else, what is most engaging about the tapes is not their content but their author. “If I were a plumber, this never would have gotten anywhere,” he correctly asserts. But because Rogers is one of the best-known entertainers in Americahe has spent an equal amount of time amassing. The tapes could mean an end to his product endorsements and his charity benefits and his appearances in that C&W retirement village, Branson, Missouri. The tapes’ notoriety might even take a cleaver to his newest enterprise, Kenny Rogers Roasters. (”It’s hard for me to believe people will walk up and say, `You have great chicken, but I’m not going in there because you had phone sex with these girls,’” says Rogers, who remains optimistic.) Only Rogers’ most fervently loyal fans believe in the best-case scenario, which is that the scandal might simply raise the visibility of a star whose light has, through the years, been dimming.

There are those who would say that this is a lawsuit with no legal basisand one in which sex is simply window dressing for much larger needs. Only one thing is certain: This is a story in which no matter who wins, everybody loses.

FOR HIM, BAD PUBlicity is like a gun to the head,” says Kenny Rogers’ bodyguard, Rob Pincus, as he winces into the April sunshine, watching his boss from afar. On the set of Dr. Quinn, Medicine Woman, outside of Los Angeles at a place called Paramount Ranch, Rogers is filming a guest shot. For the CBS drama, which stars Jane Seymour as a nineteenth-century doctor on the American frontier, Rogers will play a kindly, proud Mathew Brady-esque photographer who is losing his eyesight to diabetes. As he stands atop a scaffold adjusting his hulking wooden camera, Rogers, who is wearing a starched white collar, a woolen frock coat, and small wire-rimmed glasses, exudes the uncanny aura of a star. Dressed in period costume, he looks more like himself, not less.

His face is so familiar that you could easily mistake him for a friend. The shimmering mane of longish hair that has not changed much since the seventies, the deep tan, the casual bulkiness–all bespeak a man who cultivates his ordinariness. Except for the beard clipped with Hollywood precision, Rogers looks like the Houstonian he was, someone you might have shared a beer with, the brother-in-law you always meant to spend more time with. He is eminently approachable, the kind of celebrity who is regularly referred to by his first name, even by people who have never met him.

Which makes his current pain and bafflement all the more accessible. Rogers remembers Lisa Applewhite as a girl with problems; Dallas entrepreneur Billy Bob Harris, his close friend, asked him to help her out. He remembers Sue Ann Lenderman as a girl who told Harris that she wanted to go to a concert; he had said, “Sure, bring her along.” Though he now describes Lori Walker as “the most dangerous person I’ve ever met,” Rogers contends that they enjoyed a loving relationship for many months. “I really thought they were friends,” he says of the women who are suing him. “I know it sounds foolish and childish. We had relationships based on what I thought was honesty and caring.” Rogers insists that the women were active participants in what were healthy sexual conversations, and in Walker’s case, a healthy sexual affair. To him, the lawsuit is about one thing: money.

“They thought he would roll over,” says Mickey Newbury, who has known Rogers since he was twelve. “Kenny won’t roll over.” The fact is, Rogers’ life resembles his easygoing public image in few ways. The past fifty or so years have been, for him, a dramatic series of highs and lows, and his character has been shaped accordingly.

Rogers grew up the son of a hardworking but alcoholic father, one of eight children. His brother Randy once told a reporter that on the way to church the Rogers children hid in shame from the other parishioners. When Kenny was a boy, the family moved from a federal housing project now known as Allen Parkway Village to a part of north Houston that Newbury calls “the worst neighborhood imaginable.” The harsh violence theremade the Houston police avoid the area whenever possible. “Most of our friends are either dead or in jail,” says Newbury.

But Rogers was driven to escape, and he used music as the fuel to propel him as far from home as he could go. He wasn’t a great talent, but he was good enough, and he was a canny student of the rules of the business. Even so, his progress was initially erratic. With his brother Lelan acting as his producer, Rogers had an early hit, “That Crazy Feeling,” and appeared on American Bandstand. But by the early sixties, he was still performing in Houston jazz clubs with the locally popular Bobby Doyle Trio. (”He used to beg us to let him sing,” recalls one member of the group.) In 1966 Rogers joined the folkie New Christy Minstrels. The following year, he left with three other musicians and assumed another incarnation–as a rock singer with a band called the First Edition. Rogers had a good ear for a song; when Newbury presented him with “Just Dropped In (To See What Condition My Condition Was In),” he converted it into the First Edition’s first big hit. A gold album and a syndicated TV show would follow, but two years after the failure of Rogers’ most artistic album, a 1973 concept record called The Ballad of Calico, the group split up acrimoniously, leaving Rogers broke (he had to borrow money for rent and child support) and struggling to build a solo career. For the next two years, Rogers played Vegas lounges and made late-night TV commercials pitching music lessons. Then Hollywood heavyweight Ken Kragen, who had managed the First Edition, retooled Rogers into one of the country’s first C&W crossover stars. “Lucille,” released in 1977, signaled the beginning of Rogers’ boom years.

Superstardom included a top-ten hit, “The Gambler,” in 1978, and a Top Vocal Duo of the Year award, with Dottie West, from the Country Music Association in 1978 and 1979. The requisite movie career followed, beginning with The Gambler in 1980Country Music, Grammy, People’s Choice awards. During this period, he also shifted his persona from scruffy sex symbol to squeaky clean superstar. Concert fans brought bouquets for him and needlepoint and teddy bears for his fourth wife and third child.

It is this Kenny Rogers who sits on a sunbaked set and does not appear perturbed that his brightest days may be behind him. “Success has never been that important to me,” he says. “The minute I made a hundred dollars a week I was successful, because the most money my father ever made was seventy-five dollars a week.” Anyone who knows Rogers’ history would find his indifference to success hard to believeand besides, things aren’t so bad. He has his own TV deal in the pipeline. There are concerts on the calendar. And because he is a celebrity photographer of some renown, there’s an opportunity to take the First Lady’s portrait.

On a break from shooting, Rogers does not retreat to his trailer but simply settles into a director’s chair, and the other performers and technicians come over to pay homage to someone who has, above all, stayed in the game for more than thirty years. To each person, Rogers is unwaveringly friendly, evincing no sign of the wariness he says he has developed since the lawsuits were filed. (I say everything guardedly now,” he allows, “because I think, `My God, the last thing I want to do is make those stories sound true.’ That’s very sad to me.”) One man in his early sixties, also dressed in frontier garb, jokes with Rogers about the difference between the First Edition and the Fifth Dimension, another musical group from the seventies. A young man requests a snapshot for his father, who is a songwriter Rogers knows. A teen actress nervously tells Rogers that she loves his music; he grins and tucks his chin to hide his disbelief. A production executive introduces his wife, who works for a record company that handles some of Rogers’ songs. “Just keep recycling those hits,” he tells her.

Rogers likes this role, and he likes the role he will be playing on TV. “It pulls the heartstrings,” he explains, “just like Little House on the Prairie.” He happily amplifies the thought for a reporter from CBS This Morning. The Western genre, he says, “has an honesty, a purity, and a code of ethics we can all admire.”

This is the life Kenny Rogers has fashioned for himself. He has built it by sheer force of will, and he will not surrender it without a nasty fight. Says his friend Mickey Newbury: “He’ll destroy his own career before he’ll let anyone take advantage of him.”

“IT’S ABOUT THE DREEEEAAAM,” Sue Ann Lenderman stresses, while Lisa Applewhite nods in swift, certain agreement. Sitting at a table amid the typical Thursday night singles crush at Primo’s on McKinney Avenue in Dallas, Lenderman pecks at a heaping plate of Mexican rice as Applewhite vanquishes her enchiladas. They are both beautiful young women, though it is hard not to slip into the parlance of Rogers and his supporters and think of them as girls. Lenderman is a tiny 25-year-old with appraising, wide-spaced eyes made lily-pond green by colored contact lenses. Her stylishly teased, hennaed hair and theatrically applied eyeliner and face powder obscure her girl-next-door features; she moves and speaks slowly and deliberately, like someone who is traveling underwater or thinking very carefully. By contrast, 27-year-old Applewhite is frenetic, a nod to her days as a cocaine addict. She is pretty in a less complicated way, with long black hair, a strong chin, almond-shaped eyes, a heart-shaped face, and a desperate sincerity. Both women have the kind of body that suggests serious workouts and the improvements of a plastic surgeon.

But the dream: The dream is the explanation both women give for allowing themselves to become victims of Kenny Rogers’ sexual agenda–suffering, as their pleadings allege, “emotional distress, personal insult, and extreme humiliation.” Lenderman’s dream was different in detail from Applewhite’s, but their goals were the same: to fulfill their own notions of success. Lenderman, who today manages her boyfriend’s computer business, had hoped for a career in advertising. Applewhite, who is a program director at a Jenny Craig Weight Loss Centre, had wanted to be an actress ever since she was a little girl, when she wore her mother’s slips and pearls and pretended to be a guest on Mike Douglas’ talk show. Both women admit that they once believed in what could be called the kindness-of-strangers form of career advancement. “I knew what he wanted,” Lenderman says of Rogers, “but I wanted him to help me so bad. I thought I could make the situation work.”

Both women are good at describing “the situation.” They do not leave out as much as gloss over information that will undoubtedly be used against them at the trial: Applewhite’s drug habit, topless dancing, and lesbian encounters; Lenderman’s hot-check charges in Florida and her aborted marriage to a career criminal now in prison for killing a man. “They want to bring up every little thing,” says Lenderman. “We’re not angels,” adds Applewhite, “but that doesn’t excuse what he did.” More than a year after their encounters with Rogers, they can summon outrage that is as fresh as a cold, hard slap. The pressureshave given them a new identity: They are feminist heroines. As Applewhite told the Enquirer last November, “I decided someone has to put a stop to this pervert. And where I felt I couldn’t do it alone, I now have the confidence that Sue Ann and I can do it together.”

Applewhite’s monologue is something of a nineties morality tale. Sexually molested as a child, she has been on her own since she was fifteen, when she left home and lived in her car. “We were kind of a dysfunctional family,” she says. Eventually, she found a lifebut that was as dose to stardom as she got. Thanks to her coke habit, she blew, among other things, an audition for a bit part in Everybody’s All-American, which starred Dennis Quaid.

To get into a drug treatment program, Applewhite says, she shot herself with a.22. “I thought, `This is the only way I’m going to get into a hospital–if they think I’m serious.”‘ After a stint in rehab at Houston’s Hermann Hospital, she committed herself to Terrell State Hospital; in September of that year she joined Alcoholics Anonymous. Since then, she says, she has stayed clean, except for a few “slips,” one of which occurred when her sister died of an overdose.

In other words, the appearance of someone like Kenny Rogers in Lisa Applewhite’s life would have seemed nothing short of miraculous. But that is what happened. In 1990, Applewhite says, her mother saw a newspaper ad announcing that Rogers would be holding auditions for a movie. Her mother had been an acquaintance of Billy Bob Harris’, Dallas’ most famous raconteur, host, and networker, and she wondered if he might help Lisa land a part. (Harris’ friendship with Rogers was well known in Dallas.) Depending on whose story you believeeither Lisa or her mother called Harris, who subsequently invited the young woman to his office. “When he met me, he said, `Oh, you’re prettier than I thought,’” Applewhite recalls. Harris offered to help out, she says; he told her that he would arrange for professional photographs, for instance. But he did want to be sure she was serious about her career, and he felt that as a show of trust they should share a secret. In Applewhite’s version of events, Harris told her that he gave up recreational drugs because it was cutting into his sex life; she then told him that she had had a lesbian affair. “I told him I was really ashamed about that,” she says, her voice slowing uncharacteristically. “That was the biggest mistake I ever made.”

Soon after their first meeting, Harris promised Applewhite that she would be getting a call from Kenny Rogers, but she did not believe him. “Two weeks later the phone rings,” she says. “I’m watching Oprah and eating Cheetos. I pick it up and I hear, `Lisa, this is Kenny Rogers.”‘ The mere memory causes her to break into a broad luminous smile. “He was the sweetest, nicest guy,” she says. To Applewhite’s amazement, Rogers continued to call over the next few days, and if he missed her, he left either a long message on her answering machine or a shorter one instructing her to call his business line, an 800 number, to receive a message he would leave for her on a voice-mail system. Like a brand-new benevolent grandfather, Rogers advised her on her career (”Get a five-year plan,” he said) and her boyfriend (”Get rid of him”).

As Rogers calls became more frequent, however, they became even more personal. “What are your hands like?” he would ask. “Are your fingers long?” Over the course of the next week, Applewhite felt closer and closer to Rogers, confiding to him that she had been sexually abused as a child and that she had had not one but two lesbian affairs. Rogers was not judgmental; his only concern was that she keep their conversations secret. “The big deal, every single day, was `You haven’t told anybody that we talked?”‘ Applewhite remembers. Yet while she said she hadn’t, she had, in fact, told her boyfriend, her mother, and her AA sponsor.

“`Hey, what are ya doin’ today?’” Applewhite recalls Rogers asking her a few days after their first conversation. Applewhite replied that she was going to an AA meeting. “You want to come to New York?” he asked her. Rogers said she could audition for his movie and go to a concert. Again, Applewhite was to tell no one, but again she blabbed. Some friends were suspicious of Rogers’ motives, but she ignored them. “He’s like the Winnie the Pooh of country music,” she told one.

For the next few hours, Lisa Applewhite felt that her dream was within her grasp. There was the first-class ticket to New York that Rogers had sent to her house. There was the message from Rogers at the hotel desk: “Stay in your room until you get a call from me.” There was their warm, cuddly first meeting, at which Rogers behaved as if he were greeting an old friend instead of someone he had never laid eyes on. There was the drama of Applewhite’s pretending to be with Rogers’ bodyguard, Rob Pincus, on the way to the concert. There was the excitement of Rogers, after the concert, excusing himself to take a shower. “I’m thinking, `We’re going to go out on the town,”‘ Applewhite remembers. “`People are going to see me with him.”‘

And then, for Lisa Applewhite, things went terribly, terribly wrong. Up in his suite, Rogers made what is commonly known as a pass. He motioned for Applewhite to sit on the couch, then to lie on the bed, and began whispering a sexual fantasy about a woman on a balcony. “Kenny,” Applewhite demanded, “tell me there’s an audition tomorrow.” The rest of the night unfurled like a classically bad date. When Rogers continued his advances, Lisa stormed out, returning to her room. “I start thinking, `My career is over. Did I overreact?’ Then the phone rings. It was Kenny. He said, `You’re acting like I traumatized you. What is going on? Lisa, I thought it was okay for me to open up and tell you my fantasies. All I want to do is express my fantasies to you. I am your friend.’” Crushed, Lisa called her mother and her boyfriend in tears. Then Rogers called again, and just as the two were reaching a rapprochement, he asked, “Will you just touch yourself while I talk to you?” Incensed, Lisa hung up on him. The next morning Rogers invited her back up to the suite, where he apologized again and admonished her to keep their evening together a secret. Lisa was humiliated. She took her return ticket and headed home–coach class.

For the next few weeks, Lisa says she received anxious calls from Billy Bob Harris and more apologies from Rogers. Rogers even paid one of her medical bills and offered her a bit part in a Christmas special. But then he told her he had a confused woman friend who might benefit from learning about her homosexual experiences. Would Applewhite leave her a message on Rogers’ voice-mail system? She reluctantly agreed to do so. “Kenny called back within fifteen minutes. He said, `Lisa, that was really great. Can you be a little more explicit?”‘ After hanging up on Rogers yet again, Lisa Applewhite believed her brush with celebrity was over. Then she read about Sue Ann Lenderman in the National Enquirer.

LENDERMAN’S ENQUIRER STORY was headlined REDHEAD SUES KENNY ROGERS OVER FILTHY PHONE CALLS ON SECRET LOVE LINE, but she spins it somewhat differently. As she tells it, she was a good middle-class girl gone temporarily astray. “I was in a real transition period,” she says, her eyes sharp with newly acquired self-knowledge. “I was really on that fence and trying to stay focused.” The trouble started when Lenderman’s parents divorced while she was in high school in Oklahoma. This domestic crisis diverted her from her studies and, she says, into the netherworld of topless dancing. Like Lisa Applewhiteshe worked at the Million Dollar Saloon, but only for three months. Shortly thereafter, Lenderman married a man who called himself Tony Gambino. (His real name was Steven Michael Gerkin. A great many people who knew the couple at the time confirm that Lenderman did not know his real identity.) Lenderman moved with him around Dallas and around the country while he plied his trade as a drug dealer and jewel thief and she attempted to finish college, maintaining a 3.5 average at various schools throughout the South. When Gambino went to prison for killing a man, Lenderman got an annulment and had an epiphany. “This lifestyle has got to stop,” she told herself, and she made her way home to the University of Oklahoma.

It was then that Lenderman met Billy Bob Harris, who also figures prominently in her story–and disputes most of it. On a trip to Dallas, they had been introduced by a friend; she told him of her dream to work in advertising, and he promised to help her find a job. In 1990 she went with Harris to a Paul McCartney concert, and in March of 1991 she reluctantly agreed to go with him to a Kenny Rogers concert in Oklahoma City. “I had never been a Kenny Rogers fan at all,” she says, “but when you’re at OU…” A week before the show, Harris gave her phone number to Rogers and told her he would be calling. Lenderman thought Rogers could help her find work.

“He was real nice at first: `Where do you live? What do you want to be when you grow up?’” Lenderman recalls. Then Rogers began to call more often- four or five times a day. If Lenderman wasn’t around, he left messages for her on his 800 line. But unlike Applewhite, Lenderman didn’t have much free time. “Even though it was real charming, I was real busy,” she says. “It was like, `Dude, I got a class, I got a life, I gotta go.”‘ But Rogers did not take the hint. As with Applewhite, the conversations moved from homework and hands to, well, vibrators, rain, and a white teddy from Victoria’s Secret. It was to Lenderman that Rogers expressed the intruder fantasy and another about the upcoming concert: “I start thinking about you and I look at you and I literally see through your clothing. And I see this body and I’ve intentionally put you in the second row instead of the first row and I see that you’re really getting excited about the show…. ”

“Something bugged me,” Lenderman says. “I knew he was married. I knew he had a kid. Finally, Billy Bob calls me up and says `How is it going with Kenny?’ I said, `Billy Bob, what’s his deal?’ Billy Bob says, `Oh, he gets lonely on the road.’”

But as the concert date approached, Lenderman says, her anxiety increased. “I knew leaving the house that the guy wanted to screw me,” she says. “I was really scared. But I so much wanted these guys to help me. I figured I could finesse it.” In case she couldn’tLenderman could comfort herself with the knowledge that she had made tapes of his messages as evidence.

As it turned out, the fears she would attest to in her deposition were unfounded. After the concert, Lenderman says, she went back to Rogers’ suite with one of her girlfriends. Rogers was annoyed that they weren’t enthusiastic enough about being there: “Kenny was pacing back and forth, and we’re, like, trying to console him.” Noticing that the girls were tenseRogers kept urging them to relax. Lenderman would later allege in her deposition that Rogers offered them a drug called Restoril, and that there was some discussion of the benefits of using Alpha-Keri oil to soften skin. “We left, and I could tell Kenny was real disappointed,” Lenderman says. “I thought we had cooled him down enough.”

But perhaps Lenderman’s plan succeeded too well. Back in Dallas, Harris suddenly was unable to help her find a job in advertising. “I thought I would write it off as a lesson,” she says. But when she turned on her television, Kenny was always there. “It was A Christmas Special, The Gambler, and Kenny and his commitment and his love and his wife.”

And so, like many people with a grievance, Sue Ann Lenderman went to an attorney. She hired Robert Rose, who had successfully negotiated payment from a tabloid for a client involved in a lawsuit with a rock star. Rose listened to the tapes, told Lenderman she had “a hell of a lawsuit,” and eventually arranged for a $100,000 settlement. But there was a catch: Rogers’ lawyers wanted Lenderman to write a letter attesting that the voice on the tapes was not that of Kenny Rogers but that of an impostor.

As Lenderman remembers it, the deal made her queasy. “I didn’t want to lie,” she says, though Rose maintains that he would never advise a client to do such a thing. So she took her case to another Dallas lawyer, Ron Massingill, who in turn brought in a heavier hitter from Oklahoma, Gary Richardson, locally famous for winning a $58 million libel judgment against WFAA-TV. Before she knew it, Sue Ann Lenderman had not a settlement but a lawsuit, filed against Kenny Rogers and Billy Bob Harris in September 1992. She agreed to give her lawyers half of anything they won for her. For the moment, she put her advertising dream on hold.

“THEY CAN’T CATEGORIZE US,” Lori Walker says. “We’re all different. We all have different stories.” Indeed, the third member of the trio that collectively forms Kenny Rogers’ date from hell has a story that is substantially different from yet much the same as her co-litigants’. Walker, at 32, is older than the other two women and that much more beautiful: dark-skinned with dark eyes, opulent black hair, and what Rogers describes on tape as “the single most beautiful mouth I’ve ever seen. ” She could pass for a Cherokee princess who doubles as an aerobics instructor. Both snuggly and sharp, Walker is the only woman of the three who can legitimately claim to know Kenny Rogers. For nine months, he flew her all over the country to meet him for what could be delicately described as post-concert trysts.

Like Applewhite and Lenderman, Walker has encased her story in a moral framework. Hers is that she was a good girl who had her life together until she met Kenny Rogers. “I had nothing in my past but failed relationships,” she says. She resents the gold-digger label that has been affixed to her; she joined the suit to give support to the claims made by the others. “Women should not be threatened and manipulated by a megastar or a nobody,” she declares.

Walker is familiar with the lot of the downtrodden because of her own history: a father she barely knew, a childhood spent in foster homes, beatings. Walker, who dropped out of high school to help support her mother, says she grew up with a profound distrust of men. In 1990, following her third divorce and a subsequent failed love affair, she moved from Dallas to her mother’s home in Florida. With her second child on the way, she was worried about her future. Then her friend Billy Bob Harristhe persistent, increasingly intimate phone calls at all hours, the career- and character-building advice, including fashion tips. (On the importance of rolled-up jacket sleeves: “Up is young, down is old.”)

Three weeks after her son was born, Rogers flew Walker to a concert, ostensibly to talk business. Yet when she arrived, she found a red rose on the seat of the limo he had sent to pick her up. Walker insists that in the beginning she rebuffed such advances but eventually gave in, at which time she and Rogers began seeing one another frequently. When asked about their sex life, she offers no complaints: “It wasn’t bad. He’s very giving. He would massage me for an hour. You can’t beat that with a stick.” In between visits, Rogers continued to advise Walker on her career and her sexual growth. Her most recent love affair ended, he told her, because she did not know how to please a man. “I thought I was learning about my sexuality,” she explains. “He can talk. He is so smoothwith words.”

Eventually, Rogers introduced Walkerwas depressed and needed a boost. “What am I doing, this little girl from Florida, with a woman from The Price Is Right and Kenny Rogers?” Lori Walker asked herself.

The first answer was, shopping. According to Walker, Rogers gave her and Parkinson $2,000 apiece. “He said, `Go buy something that makes you look sexy and feel good about yourself.’ We shopped our butts off.” The women hit Victoria’s Secret particularly hard; Rogers had wanted them to buy matching outfits, she says, to perform a fashion show for him that night. Walker’s version of what followed was the high point of A Current Affair’s segment on the scandal. Rogers tried to initiate what the show calls, with elegant simplicity, “an orgy.” While Parkinson has denied both the shopping trip and any sexual encounters, Walker has testified in a sworn deposition that Rogers instigated three-way sex. Walker says she was an unhappy and passive participant and left Las Vegas emotionally shattered.

Sometime after that incident, Walker, who maintains she has always saved her old answering machine tapes for reuse, began supplementing that collection. Like Lenderman, she began using another tape recorder to tape messages Rogers left for her on his voice-mail system, as well as those he left for Parkinson. “I was trying to understand what had happened,” she says. It dawned on her that perhaps she was being used as a “sexual toy.” As Walker would testify in her deposition, when she tried to break off the affair on a subsequent visit to Los Angeles, Rogers grabbed her by the hair, shoved her into a mirror, and warned her that she would be sorry; she needed him, he said. Devastated, she moved her family back to Texas, and because she had no money for diapers or formula, she briefly took a job dancing at Fantasy Ranch, a topless bar in Fort Worth. Sick about her encounter with RogersWalker phoned the National Enquirer. She says she wanted to stop Rogers from abusing other women. The first two questions the reporter asked her were, “What’s your name?” and “How much do you want?”

The Enquirer story ran under the headline, KENNY ROGERS’ SECRET LOVE HOTLINE… SEXY GIRLFRIENDS COAST TO COAST TAKE HIS ROMANTIC CALLS–AND HIs WIFE DOESN’T KNOW. Walker’s identity was not revealed. That would come later, after she got to know Sue Ann Lenderman, Lisa Applewhite, and Gary Richardson.

“WHEN I WAS A LITTLE KID, MY mama told me there’s a favor bank in heaven,” Billy Bob Harris says, “and you rarely make a withdrawal from the same window you make a deposit.” At 53, he is older now than when he posed for a 1979 D magazine story titled PLAYBOY OF THE WESTERN WORLD, but he remains small and delicate, impeccably fit and irrepressibly sunny–at least until mention of the lawsuit in which he, along with his old friend Kenny Rogers, is being sued for despoiling the lives of Applewhite, Lenderman, and Walker. It was Gary Richardson’s idea to add Harris’ name to the lawsuit and to portray him as the pimp who ferried the unwitting victims to the sexually voracious Rogers. The very thought of such a portrait causes Harris’ gnarly hands to shake; sometimes he buries his head in his hands. He is just a farm boy from the Panhandle town of Gruver, he insists; he came to Dallas with nothing but his smarts, his quick wits, and a fervent eagerness to please. “It’s