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Title: FDA APPROVES PILL TO TREAT impotence ,  Jet, 00215996, 04/13/98, Vol. 93, Issue 20

Section: Medicine

Millions of men soon will have access to the first pill to treat impotence .

The Food and Drug Administration (FDA) recently approved Pfizer Inc.’s new pill, Viagra, saying it helped about two thirds of impotent men improve their sexual function.

The prescription pill becomes the first nonsurgical treatment for impotence that doesn’t have to be either injected or inserted directly into the penis. Unlike other remedies, it does not cause an erection until the man is sexually stimulated.

The price per pill is between $7 and $9 and will be available only by prescription. The Pfizer company said it will begin shipping the new pill to pharmacies within two weeks.

Between 10 million and 20 million men suffer impotence at some point in their lives.

Title: USING VIAGRA ,  American Family Physician, 0002838X, 09/15/99, Vol. 60, Issue 4

Information from Your Family Doctor

Viagra is the brand name for sildenafil. It’s a medicine that helps men with erectile dysfunction have sex again.

Erectile dysfunction is the inability of the penis to become rigid, or to stay rigid long enough to complete the sex act.

Take one tablet one hour before you plan to have sex. Don’t take more than one tablet in 24 hours. The medicine comes in tablets of 25 mg, 50 mg and 100 mg. Most patients start with 50 mg.

Even if you take Viagra, you still need physical and mental stimulation and desire to have an erection. If your first dose of Viagra doesn’t help, call your doctor. Your doctor may want to change your tablet size.

Viagra has some common side effects:

• Headache
• Flushing (face and upper body turning red and warm)
• Stomach upset
• Runny nose (sniffles)
• Vision changes (things look blue)

Headache is the most common side effect. Vision changes are the least common. Talk to your doctor if you have any side effect that bothers you.

You shouldn’t use Viagra if you take any of these forms of nitroglycerin or any other nitrates:

• Isosorbide mononitrate (brand names: Ismo, Monoket, Imdur)
• Isosorbide dinitrate (brand names: Isordil, Sorbitrate)
• Sublingual nitroglycerin tablets or spray (brand names: Nitrostat, Nitrolingual Spray)
• Transdermal nitroglycerin patches or paste (brand names: Minitran, Nitro-Dur, Transderm-Nitro TTS)

If you use Viagra and get chest pains, be sure to tell the paramedics, nurses or doctors at the hospital how long ago it was that you last took Viagra.

Title: Cross-Gender Sex Pill ,  By: Mann, Arnold, Time South Pacific, 08180628, 04/13/98, Issue 15

Section: Medicine

IRWIN GOLDSTEIN COULD HARDLY WAIT for the FDA to approve Viagra. The renowned Boston University urologist is so excited about last month’s approval of the first-ever impotence pill for men that he is opening a new sexual-dysfunction clinic, and will soon begin prescribing the drug-for women.

As doctors learn more about the causes of impotence, they’re becoming increasingly convinced that the underlying mechanisms of male and female sexual dysfunction may not be so far apart. And if that’s the case, it’s entirely possible that the same pharmacological science that restores sexual function to men can work similar magic in women.

Viagra trials in women are already under way in Europe. This month the FDA is holding an invitation-only meeting of scientists and pharmaceutical executives to discuss possible testing and use of the drug in women in the U. S . And in June leading sex researchers will devote their annual meeting in Cape Cod to discussing how a range of impotence drugs might be tested in female p atients. If the medications prove effective, they could offer women a safer alternative to the current best weapon against female sexual dysfunction, hormone-replacement therapy, which carries a slightly increased risk of cancer. Meanwhile, with the approval of Viagra (release date: mid April) as an impotence treatment, doctors will be able to prescribe it “off-label” for women too. “We intend to use it in women once it’s released for men,” Goldstein says. “Not even a question.”

Viagra’s effects on the hydraulics of male sexuality are pretty straightforward. Originally developed as a heart medication, the drug works directly on the blood vessels, blocking an enzyme called phosphodiesterase. This enzyme prevents the release of certain neurotransmitters-most notably one called cyclic GMP-that cause the smooth muscles surrounding the arteries to relax, a llowing the arteries to expand. When this occurs in penile arteries, it leads to engorgement, which leads to erection.

While Viagra doesn’t work for every impotent man, it does work for up to 80% of them. “There appears to be no group that has been tested that has a zero response,” says urologist Dr. Harin Padma-Nathan of the University of Southern California. Even men with the most severe forms of impotence-spinal-injury victims, diabetics, those who have undergone prostate-cancer surgery–have responded.

Such results ought to mean good things for women too. Female genitals fill with blood during sexual stimulation just as male genitals do, resulting in engorgement of the clitoris and lubrication of the vagina. As women age, they experience some of the same genital problems men do, as a number of ailments-particularly atherosclerosis and diabetes-impair blood flow; this leads to vaginal dryness, pain during intercourse and problems in achieving orgasm. Indeed, according to one study, more than a th ird of women in the 18-to-59 age group experience sexual dysfunction, compared with just 10% of men. “Male sexuality has always been viewed as more important, says Julia Heiman, a psychologist at the University of Washington and one of America’s leading experts on female sexual dysfunction. “A man needs an erection to have intercourse, so it’s easy to regard a man’s sexuality as important and interesting pastime.”

How effective Viagra is come of the tests. The FDA and Pfizer, the manufacturer, do not encourage women to use it. “We strongly recommend against women taking their husband’s pills or physicians using it off-label,” says Raymond Rosen, professor of psychiatry at the Robert Wood Johnson, who will chair the Cape Cod.

Still, some physicians see potential benefits in careful, off-label use of the new drug. Goldstein plans to test female patients-mostly postmenopausal women- for impaired blood flow and give Viagra to those he thinks it can help. He has already received E-mail from women eager to try it. Other doctors are bracing for the same. “The Viagra avalanche is about to begin,” says Rosen. “Where the oral contraceptive was liberating for younger people, Viagra may be the sexual-liberation pill of older adults.” This time both men and women will be getting in line.

~~~~~~~~

By ARNOLD MANN

Viagra (chemical name: sildenafil): Relaxes muscle cells to enhance blood flow. Early female trials under way in Europe: U.S. female trials will be discussed at an FDA meeting later this month

Vasomax (phentolamine): Oral version of an approved injectable drug. Dilates blood vessels to increase flow. Male trials are near completion in the U.S.; female trials are planned

Spontane (apomorphine): Works through the central nervous system. Male trials are nearing completion; female trials are planned

Prostaglandin creams: Applied to the surface of the genitals to stimulate blood flow. Male trials are under way; female trials are planned

ILLUSTRATION

Title: DIARY FROM A WEEK IN PRACTICE ,  By: Larimore, Walter L., Hartrnan, John R., Frisbie, Stephanie E., Griffin, Chad A., Littell, John T., American Family Physician, 0002838X, 7/1/99, Vol. 60, Issue 1

CAG received an excellent suggestion from our nurse practitioner, Lori White, for giving eye drops to children and adults. The patient lies supine with the eyes closed, and another person places two drops in the medial canthus of each eye. Once the eyes are opened, the medicine bathes the eyes without much discomfort. CAG has found this technique to be helpful for parents who prefer eye drops over ointment for children and for adults who have difficulty putting drops directly in their eyes.

In a past diary (September 15, 1995), WLL shared another technique. The child lies on his or her back and keeps the eyes closed. Two ophthalmic drops are placed into the inner canthus and then, with the child’s eyes remaining closed, the drops are gently rubbed to disperse the medication throughout the eye. WLL came across a study in the August 1991 issue of the British Journal of Ophthalmology (page 480), titled “Eyedrop Instillation for Reluctant Children” which documented this technique and showed that instillation using this simple technique resulted in “66 percent of that obtained by conventional instillation.” Both methods are surely easier for parent and child.

Today, a 20-year-old man presented for a new-patient visit after his girlfriend suggested that he get a prescription for viagra . JTL told the patient (who was not dealing with erectile, but rather sexual, dysfunction) that he had no medical indication for using viagra . JTL also went on to explain that because of his own personal convictions, he does not prescribe agents such as sildenafil without proper indications. The patient, visibly disappointed, although not angry, ultimately left without a prescription. JTL reflected on how often he has, for similar reasons, found it necessary to refuse to comply with patients’ requests when they conflict with his principles–and wondered whether many other family physicians find themselves doing likewise.

Like most of you, we take the occasion of preparticipation sports physicals or preemployment physicals to check up on our patients’ immunizations. Today brought in a young woman who was applying to an emergency medical technician school. As expected, she was in the peak of health, but she needed an update on her adult diphtheria-tetanus immunization. After explaining the side effect of muscle soreness, lasting one to two days, JRH inquired which hand was dominant, so the nurse could give the shot on the opposite side. “But I’d rather have it on my right side” the patient retorted. “You would?” replied JRH incredulously. “Sure, because when I waitress, I have to carry the trays on my left, and I’m afraid I would be just too uncomfortable when I’m trying to smile.”

One of the more interesting phenomena in medicine is patients’ use of the phrase, “Oh, by the way” or “OBTW” for short, during office visits. Although this phrase is variously interpreted to be a nuisance, a bait-and-switch ploy or a hidden agenda, we occasionally take reassurance from the thought that it exemplifies our patients’ trust in us–for both our experience and our willingness to listen. Today JRH was near the end of a visit with a middle-aged woman who had come in for evaluation of hypertension, when she mentioned in passing that her toe would sometimes get “stuck” in the flexed position and wouldn’t return to neutral unless she bent over and moved it. Being accustomed to treating trigger finger first with a nonsteroidal anti-inflammatory drug and later with an injection of triamcinolone, JRH explained this course of treatment to the patient and showed her, using his own finger, how this phenomenon develops and how the treatment relieves the problem. This was JRH’s first case of “trigger toe,” but one that will be remembered, thanks to the four little words: “Oh, by the way.”

A recent headline in one of the medical newspapers cited how patients enjoy physicians who spend time “chatting” with them. In fact, chatting may provide the most important information for the patient-physician relationship. Today, JTL visited with a 70-year-old German-American woman who has been known to be quite demanding with the front office staff and nurses. She refuses to wait even a few minutes for the doctor and will not sit in a closed examination room alone because she has claustrophobia. This patient generally has a list of tests that she wants performed–and she is rarely receptive to any suggestion that such tests might not be warranted. JTL has, however, found it easier to tolerate this patient’s controlling behaviors after learning that, during her youth, she escaped from eastern Germany during World War II, and only a few years later had to escape from USSR-controlled Poland back to (West) Germany. At times, information such as this is helpful to office staff who otherwise may feel quite frustrated after long days of dealing with such “difficult” patients.

Probably the hardest part of being a physician is knowing when not to take on that role. SEF’s father was recently diagnosed with prostate cancer that appeared to be contained in the prostate. His urologist had recommended a radical prostatectomy, since he was in excellent physical shape otherwise. Her father was unsure about what to do and was also uncomfortable with his urologist for various reasons. SEF encouraged him to come to Florida for a second opinion and possible surgery with a group of urologists that she recommended. He agreed and made the trip. At the consultation, the urologist outlined all of the options, including surgery, radiation implants and external radiation. SEF did not give her opinion until after her father had made his informed choice, knowing that he needed to be completely comfortable with his decision. He elected to have the surgery, and the urologist was pleased to report that all of the nodes were negative. SEF then played nurse for the two-week recovery period and sent her father back to Missouri in fairly good shape–but minus his prostate. Despite the difficulty of the situation, both enjoyed their unexpected time together.

~~~~~~~~

By Walter L. Larimore, M.D.; John R. Hartrnan, M.D.; Stephanie E. Frisbie, M.D.; Chad A. Griffin, M.D. and John T. Littell, M.D.

Adapted by M.D. , M.D. , M.D. , M.D. and M.D.

Title: VIAGRA: BEYOND THE JOKES ,  Harvard Heart Letter, 10515313, Oct98, Vol. 9, Issue 2

For months now, Viagra has been a source of intense interest and an endless supply of jokes. The fact is that this pill can help as many as 69% of men with impotence achieve erections sufficient for sexual intercourse. This medication seems destined to be among the most commonly used drugs in this country. Its availability is creating interesting social issues as sexual lives are renewed for many men in their 60s, 70s, and beyond — and for their companions.

Since impotence is common among people with heart disease, Viagra is a particularly important topic for readers of the Harvard Heart Letter. And while the risks of serious complications from this drug are actually very low, people with heart disease are the ones who are most vulnerable to these side effects. What follows is a primer on the special concerns about Viagra for people with cardiovascular conditions.

impotence is so prevalent among men with heart disease that all too often it is accepted as “just the way things are going to be.” The most common diseases that cause impotence are atherosclerosis and diabetes. Just as atherosclerosis can block blood vessels in the heart, it also can impede blood flow to the penis, thereby weakening or preventing erections. Diabetes is, of course, an important risk factor for atherosclerosis, but it also can contribute to impotence by damaging nerves in the penis. Some data suggest that half of male diabetics have problems with impotence .

Even if these disease processes themselves do not cause impotence , many of the medications used to treat heart disease might. Two classes of drugs that can cause impotence are beta blockers (such as atenolol, propranolol, and metoprolol) and diuretics, such as hydrochlorothiazide.

Of course, sex requires more than just having functioning equipment. Many experts believe that an absent or reduced sex drive (libido) is the greatest contributor to sexual problems for heart-disease patients. Depression is quite common among people struggling to live with a heart condition, and this mood change often lowers interest in sex. Even if libido returns to “normal” as patients adjust to their condition, some couples may have difficulty resuming their sexual relationship because the patient or spouse fears that doing so may trigger a heart attack.

In an ideal world, men with impotence would undergo a medical evaluation to determine what, if any, conditions (for example, diabetes) might be contributing to this problem. Their physicians would review all medications and determine whether altering these regimens might correct the problem. Finally, a frank discussion about the patient’s and spouse’s fears would take place and most likely relieve many of those concerns.

Unfortunately, this ideal scenario occurs all too rarely. Because so many men are understandably reluctant to talk about this private problem, impotence remains a silent epidemic. Perhaps one of the best “side effects” of Viagra is that it will encourage men to discuss impotence with their doctors, probably for the first time.

Of course, Viagra does more than lead patients to their doctors. This drug blocks an enzyme that breaks down a chemical called cyclic GMP that helps the penis fill with blood. Higher levels of this enzyme can help initiate and maintain an erection.

However, Viagra cannot do all the work itself. Sexual stimulation is needed to trigger this chain of events. Such stimulation leads to neurological signals that cause cells in the penis to generate cyclic GMP in the first place.

Men should take Viagra one hour before the expected time of intercourse. Viagra is available in 25-mg, 50-mg, and 100-mg tablets. Most physicians start men on the 50-mg tablets and increase the dosage to 100-mg if necessary. For some, the 25-mg dosage is effective.

Ironically, Viagra was initially developed and tested as a treatment for coronary artery disease. While it did not do much for heart disease, it did improve sexual function in many men participating in the trial. Such reports rescued the drug from oblivion. Viagra underwent extensive testing before the U.S. Food and Drug Administration approved it as a treatment for impotence . How, then, could it be dangerous for people with heart disease?

The primary reason is that many people with coronary artery disease use various forms of nitroglycerin and other medications that fall into the category of “nitrates.” Viagra and nitrates have some similar effects and when used together can lead to profound drops in blood pressure. Drugs in the nitrate category include long-acting preparations used to prevent angina (including Imdur, Ismo, Sorbitrate, and Isordil) and the small nitroglycerin tablets that people commonly put under their tongues during episodes of chest pain. Finally, this class of drugs also includes substances that are abused by some people as sexual stimulants (for example, amyl nitrate).

Accordingly, Pfizer (the manufacturer of Viagra) and physicians have emphasized repeatedly and emphatically that these drugs should never be used together. Still, several deaths have occurred among men who have used Viagra and nitrates.

Another scenario involved men who did not know they had heart disease (and therefore were not using nitrates) and who developed angina or heart attacks during sex made possible by Viagra. In some cases, physicians treating these men were unable to administer nitroglycerin because of the presence of Viagra. Alternatively, some doctors, unaware that the patients had taken Viagra, administered nitroglycerin with disastrous effects.

The cardiovascular effects of Viagra suggest that there may at least be a potentially small increase in risk of this drug for patients who:

have coronary ischemia, even if they are not taking nitrates

have congestive heart failure and borderline low blood pressure

take several medications for high blood pressure

take other medications such as erythromycin or cimetidine or who have other conditions (such as liver or kidney disease) that might prolong the half-life of this drug

Finally, some of these deaths almost surely occur because many elderly men are undergoing the physical and emotional stress of sex for the first time in many years. In general, the stress of sex does not pose major risks for people with heart disease. However, there are not many “rigorous” studies of this topic. Does Viagra make sex more dangerous for elderly men? It is difficult to know in the absence of information on the risk of death for these men if they were not having sex or the risk of death if they had sex without Viagra.

It is true that men who take Viagra may have a slight increase in heart-attack risk during sex. But this possibility does not mean that Viagra is a bad drug. In fact, it is a very good drug that is improving the quality of life for many couples.

Nevertheless, men with known heart disease should use this drug with caution. Men who experience symptoms suggestive of a heart attack, such as chest pain or pressure, should seek medical attention promptly and be certain to alert physicians that they have used Viagra. And no one should combine nitrates with Viagra. Ever!

There are not yet data on the benefits of this drug except in men with impotence . Individuals without a diagnosis of medical impotence should not use Viagra. Any possibility that Viagra might enhance sexual experiences for women or for men without impotence is offset by the small but real risk of complications.

Finally, whether or not they decide to try Viagra, men with impotence should openly talk about this problem with their physicians. That discussion alone may improve care of the medical problems that can contribute to the sexual dysfunction.

Title: PROSTATE CANCER ,  By: Simmons, Judy Dothard, Crisis (The New), 00111422, Sep/Oct98, Vol. 105, Issue 4

Section: HEALTH WATCH

Last April, Harold Dudley, a mortgage loan officer in Birmingham, Alabama, celebrated his forty-eighth birthday twenty-eight months after he underwent radical surgery to remove a cancerous prostate gland.

“After they took out as much tissue as they could, they were still afraid some cancer cells had gone into the bladder,” said Dudley. The prostate gland’s location allows malignant cells to migrate easily around the pelvic area. “Over the next six weeks I had thirty short-duration radiation treatments. It was low-dose, so it wasn’t painful.”

Dudley mentioned that prostate cancer survivors include such prominent men as Harry Belafonte, General Norman Schwarzkopf, and Louis Farrakhan. “I read a lot about it once I was diagnosed and realized I could die,” Dudley said. After lung cancer, prostate cancer is the leading cause of cancer deaths for men in the U.S.

Dudley was 45 and living in Hempstead, New York, when the cancer was detected. He had a standard yearly digital rectal examination (DRE) and a blood test that measures the level of prostate-specific antigen (PSA), a protein made by prostate cells. The test has been in widespread use for just about a decade.

“Anybody over forty, with a family history of prostate cancer should have a yearly exam and PSA,” said Dr. Manoj Subudhi, the Garden City, New York, urologist who operated on Dudley. Subudhi explained that irregularities in the gland’s texture and/or higher antigen levels can indicate other problems like prostatis (inflammation) or benign prostatic hypertrophy (enlargement), not always cancer.

An internal scan with a rectally inserted ultrasound wand is the next step. Following that, if necessary, is a needle biopsy that samples tissue from several different areas of the gland. It takes about a half hour in the office, Dr. Subudhi said, admitting that it is somewhat uncomfortable. Dudley said, “It felt like a nail. I was wounded. Then I had to lay there knowing he was going to do it five more times.”

Dudley’s age, condition, and stage of cancer called for a retropubic prostatectomy–removing the gland through an incision from the navel to the base of the penis. Treatment of prostate disease can include: waiting and watching; undergoing radical surgery; seeding the tumor with radioactive material; and/or using external radiation therapy. If the lymph system or bones are affected, hormones may be used to reduce testosterone.

Dr. Subudhi didn’t bite on the gee-whiz figure that black men here have the world’s highest prostate cancer rate. “We don’t know what the rate is everywhere, not in India or Africa.” He said race is less important than age. A PSA level of 2.5 at age 50 may indicate as serious a condition as a PSA of 5 for a 70-year-old. But National Cancer Institute data show that prostate cancer occurs among black men at a higher rate than in the general U.S. population. A similar discrepency occurs with several other serious diseases among black people.

“We still are very slow about our medical health and getting regular exams,” said Dr. J.W. Pitts., Jr., an internist with Acipco, a major Birmingham manufacturer. Yet prostate cancer, like hypertension, often lacks symptoms. “It’s a silent problem,” Pitts warned. Black men are advised to begin yearly screening at age 40 rather than 50, and to make their doctors aware that black men may be in more trouble at lower PSA levels than white norms predict.

Dr. Pitts mentioned men’s fears about impotence and urinary incontinence after prostate treatments. ‘”My sex life is over’ is often their first comment, but then they want to know how far along it is and what their options are. Surgery is the least popular,” Dr. Pitts said, “but I have had a number of guys who opt for it because it gives them some confidence that their cancer is cured.”

Loss of function can occur, but in most instances it is reversed through healing time and various therapies. Doctors Subudhi and Pitts, and survivor Harold Dudley, urge that men not let fear and ignorance snatch away their mellow years with their loved ones. For more information, call 800-4-CANCER.

S (COLOR): Survivors of prostate cancer: Norman Schwartzkopf Harry Belafonte and Louis Farrakan

~~~~~~~~

By Judy Dothard Simmons

Title: Company’s latest cute gadget takes death-defying first steps ,  USA Today, OCT 02, 2002

Section: Money, Pg. 03b

PALO ALTO, Calif. — This might be Andy Rubin’s last chance to avoid becoming the Bob Dole of technology.

You might remember Dole. Kept trying to be president. Great senator, likable guy, knew all the right people, did all the right things — but just couldn’t win the Big One. Wound up being known for introducing the term “erectile dysfunction” into polite conversation.

Rubin has a new company called Danger, and if this one doesn’t soar, he too might have to find refuge as a spokesman for a malfunctioning body part.

Danger’s “hiptop” computer landed on store shelves Tuesday. The company has gotten a ton of publicity because it has created the cutest piece of technology in years: a friendly wireless Internet gadget about the size and heft of a thick pork chop.

The thing is, Rubin and his entrepreneurial pals have a long history of creating the cutest pieces of technology in years. They keep starting companies that develop brilliant, forward-thinking, critic-pleasing consumer devices that flop. These guys produce technology the way Orson Welles produced films.

Danger’s founders met at Apple Computer just before that company headed toward its near-death experience. Rubin, Danger’s CEO, moved on to General Magic and WebTV. Joe Britt helped build 3DO and WebTV. While at Apple, Matt Hershenson helped design the PowerBook 150 laptops, which are much-loved but rarely seen — like pandas.

Between them, they haven’t been able to turn a start-up into a highly successful, high-impact company or product. Do you use a General Magic operating system? I didn’t think so. You surf the Web on your TV set? Not many people do. Own a 3DO video game console? 3DO developed the technology of the PlayStation back before Sony had a clue, but nobody at the time knew what to do with a CD-based game machine. I hear they make good trivets.

Rubin obviously has faith in his current effort.

“We want to be the first data device for the mass market,” Rubin tells me as we sit at Danger’s de facto satellite headquarters, Caffe Verona in downtown Palo Alto.

Danger’s real office is a few blocks away. We’re at this airy coffee shop because when Rubin signed the lease for his headquarters, he didn’t know the building used to be a dentist’s office. The dentists had to put a protective lead lining behind the walls to keep X-rays from leaking out. The lead also keeps all radio waves from coming in. So, here’s a wireless communications company operating in a building sealed off from wireless signals. Makes it hard to give demos.

Anyway, in the cafe, Rubin shows me his product. It’s wonderfully designed, with a cool screen that flips around to reveal a tiny thumb keyboard. It can do e-mail and get on the Web. When you call up a Web page, you see everything you’d see on a PC screen except squished vertically. It is also a cellphone.

“This really is the razor blade,” Rubin says of the gadget, messing up the old analogy. Actually, the device is the razor, which the company plans to sell at cost. The razor blade will be the service behind the device.

For instance, Danger is selling its devices to T-Mobile, which will sell them to consumers as the T-Mobile Sidekick for $199 and a package of wireless services. For $39.99 a month, you can get a big basket of minutes on the cellphone and unlimited use of the data service.

Danger will operate the computers that make the wireless data service work, and T-Mobile will pay Danger part of the monthly fees collected from consumers.

Danger’s cute factor is a key piece of genetic code in its heritage. Ten years ago, I visited General Magic when it was full of promise. The company was funded by the likes of AT&T, Philips and Sony. With Motorola, it made the Envoy — a book-size wireless device with an interface that you navigated by moving down a cartoon street and going into an online “store” to shop or a “library” to do research in a “library.” This pre-dated the Internet boom or wireless data services.

“We went overboard making it fun or cute,” Marc Porat, General Magic’s CEO back then, told me in his office. Rubin had worked on the Envoy.

It was all way far ahead of its time. “We’d say, ‘And it does e-mail!’ ” Rubin says now. “And people would say, ‘Uh, what’s e-mail?’ ” Next thing they knew, the Internet, Microsoft Windows and Java blew General Magic out of the water.

Similar story at WebTV. It won kudos for being cute and easy to use. Seemed like the right idea at the right time. But it sold like tea and crumpets at a NASCAR race.

Microsoft scooped up the company in 1997 for $425 million — which certainly isn’t bad, but then again, WorldCom executives allegedly hid more than that on their lunch breaks.

On the Danger device, icons are set up in a wheel. Scroll around it and up pop cartoon images such as a rocket ship or people talking on cellphones. Like a lot of cellphones, it can be set to vibrate when someone calls. Danger’s can be set to vibrate differently, depending on who calls. “So you can feel who it is,” Rubin says.

For the most part, Danger’s hiptop is fun and easy to figure out.

T-Mobile, which is owned by Germany’s Deutsche Telekom, is pulling out the stops for Danger. It’s hired movie goddess Catherine Zeta-Jones as a spokeswoman. It is sponsoring what will be the first-ever outdoor concert on Alcatraz Island off the coast of San Francisco, featuring neurotic head-banger band Creed, which sings cheery, purchase-inducing lyrics such as:

Look at me, look at me

At least look at me when you shoot a bullet through my head

Maybe, after several tries, Rubin and friends have finally figured out how to make cute technology sell. Maybe Danger will take off.

And if not? Rubin will have effected change by pushing the technology at each of his stops. There’s a lot to be said for playing a Dole-like role in the industry. It beats a lot of other CEOs making headlines lately.

—

E-mail kmaney@usatoday.com

(c) USA TODAY, 2002

Title: CALPERS GRAPPLES WITH RATE HIKES, DEMAND FOR viagra ,  By: Bosetti, Diana, Orange County Business Journal, 10517480, 06/22/98, Vol. 21, Issue 25

Section: HEALTHCARE

The California Public Employees Retirement System, the largest public pension system in the nation and a group that many employers turn to when gauging healthcare benefit trends, said it’s expecting substantial premium increases next year, particularly at Kaiser Permanente.

That’s according to Margaret Stanley, a health benefits administrator for CalPERS, who spoke at a recent Orange County Employee Benefit Council meeting.

“We believe it’s going to be an increasing challenge to hold the line in healthcare costs,” Stanley said.

CalPERS and Kaiser have tentatively agreed to a 10.75% rate hike for Kaiser, below the 12% increase that the HMO suggested a few months back.

Stanley said the average rate hike for next year, based on the group’s contracts with other HMOs, is 5%. She added that 80% of CalPERS’ 1 million members are insured either by PacifiCare, Health Net or Kaiser.

Stanley warned that rates might go up even more in the future, if the popularity of viagra continues.

“Our phones have been ringing off the hook,” said Stanley, who poked some fun at the situation when she said CalPERS’ 22-year-old (on average) female service line operators were provided with scripts on how they should respond “to the appeals from 85-year-old men on why they need this.”

Regardless, Stanley said CalPERS is weighing the potential costs associated with viagra , and said Kaiser recently informed her that the drug might increase the HMO’s drug spending rate by up to 10%.

That’s greater, Stanley said, than the costs for all antibiotics, including those for AIDS patients, combined. “So we are not talking about an insignificant cost here.”

Placentia Linda Hospital, a 114-bed facility owned by Tenet Healthcare Corp., is busy these days on account of the May 15 closure of MedPartners’ Friendly Hills Regional Medical Center.

“We’re getting up to 25 additional in-patients per day,” said Jim Fenstermaker, a Placentia Linda spokesman.

Before Friendly Hills closed it doors, MedPartners signed an agreement with Tenet to refer the 116,000 patients it treated either to Placentia Linda or to Whittier Hospital Medical Center, another Tenet-run facility to the northwest.

“This is a tremendous agreement for us, we anticipate about double the number of patients we are now treating,” said Maxine Cooper, Placentia Linda’s CEO.

Placentia Linda has roughly 250 physicians on staff, but is processing the applications of 100 more to help handle the increased workload.

Placentia Linda is also planning to renovate the interior rooms and lobby areas, and Whittier hospital is planning a $15 million expansion that will include converting a skilled nursing unit into a medical surgical unit, and hopes to expand the number of labor, delivery, recovery and postpartum rooms and outpatient rooms after that. The entire project would take about two years to complete.

Bergen Brunswig Corp., Orange, launched Integrated Commercialization Solutions, a subsidiary that will help market new product lines for pharmaceutical and biotech companies.

Neil Dimick, president of Bergen Brunswig Speciality Company, which will be the parent company of ICS, said ICS will utilize provider relationships already in place at Bergen’s sister companies: ASD Specially Healthcare, Bergen Brunswig Drug Company and Bergen Brunswig Medical Corp.

Bergen Brunswig Corp. is a Fortune 500 company with annual revenue of $13 billion. ICS will be based in Dallas, and will include 55 new employees, with plans to more than double that by the end of the year.

Express Scripts Infusion Therapy Services, a St. Louis, Mo.-based managed care and pharmacy benefit management company, said it will use Mission Viejo-based Venetec International’s StatLock IV catheter securement devices at its branch offices.

The StatLock is designed to eliminate the use of tape and sutures, and is said to carry no risk of IV catheter disconnection.

The deal is expected to boost sales for Venetec, which will be able to tap into Express Scripts’ large network of managed care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts also recently acquired ValueRx from Nashville, Tenn.-based Columbia/HCA Healthcare Corporation.

Bits and pieces:

Santa Ana-based PacifiCare Health Systems’ proposed $250 million bond issue was rated BBB by Standard and Poor’s … Irvine-based Advanced Spine Fixation Systems Inc. acquired the exclusive marketing and distribution rights to the LIFEC Expandable Cage Implant System, an implantable cage designed to maintain the spine’s natural curvature, and which is manufactured by a company in France called Proconcept … ICN Pharmaceuticals Inc. said its acquisition of VUAB, a 500-employee manufacturing and research facility in Prague, is close to receiving final approval. It recently got a thumbs up from National Property Fund of the Czech Republic, and is hoping to get approval from the Antitrust Committee of the Czech Republic soon … San Clemente-based ICU Medical Inc. finalized a manufacture and supply agreement with B. Braun McGaw.

PHOTO (BLACK & WHITE): Diana Bosetti

PHOTO (BLACK & WHITE): Placentia Linda Hospital: getting busier

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By Diana Bosetti

Title: Ask the Doctor ,  By: Lee, Thomas H., Harvard Heart Letter, 10515313, Nov99, Vol. 10, Issue 3

Q. I tried Viagra for impotence and it didn’t work. Is there anything else that I can try?

A. There are some new drugs that will be available for testing in the near future, and it is possible that one of them might help you. In the meantime, you might look into older treatments, such as injection therapy (in which a drug is injected into the penis before intercourse) or surgery to implant a mechanical device in the penis.

Whether or not you choose to investigate one of these strategies, it is important that you get a medical evaluation for reversible causes of impotence . Lifestyle factors such as alcohol consumption may be contributing to this problem. Also, your doctor should review the medications you are taking to be sure that none of them might be causing impotence . Your doctor should also do blood tests, such as checking your testosterone level, and evaluate you to be sure you do not have undiagnosed or poorly controlled diabetes. Finally, you should discuss the possibility that psychological factors, such as depression, might be affecting your ability to achieve or maintain erections.

Address your questions to Dr. Thomas H. Lee, Harvard Heart Letter, 164 Longwood Avenue, Boston, MA 02115. Selected questions will be answered in this space, but personal responses are not possible.

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By Thomas H. Lee, M.D.

Title: VIAGRA IS SAFE FOR SOME MEN WITH HEART DISEASE ,  Harvard Heart Letter, 10515313, May2002, Vol. 12, Issue 9

Section: Heartbeats

Now that the hype and giddy media attention have faded and Viagra has become an established treatment for erectile dysfunction, questions still linger about its safety for men with heart disease. Published guidelines say that Viagra ( Sildenafil ) could be hazardous for men with angina (chest pain) or other types of ischemic heart disease. Yet it is entirely possible that heart attacks, heart rhythm problems, and even sudden deaths among Viagra users with heart disease are caused by the stress and exertion of sexual activity, or to the combination of Viagra and nitroglycerin, and not to Viagra itself.

So Mayo Clinic researchers tested Viagra’s effects on the racing heart in a study that had men bicycling on their backs to simulate the effort of sexual activity. More than 100 men between the ages of 43 and 87, all of whom had heart disease, took Viagra or a placebo pill. An hour later, each man pedaled a “supine” cycle while his heart function was monitored continuously.

Compared with the placebo, Viagra lowered blood pressure a small amount, about 4 mm Hg. But it didn’t shorten the time the men could exercise without experiencing chest pain or becoming short of breath. Nor did it reduce blood flow through the heart’s arteries. (Journal of the American Medical Association 2002, Vol. 287, No. 6, pp. 719-25.)

This innovative study and others like it (see Harvard Heart Letter, August 2000) suggest that Viagra can be an option for some men with heart disease. If you can climb several flights of stairs or walk briskly (about 4 miles an hour) for 30 minutes or so without chest pain and without needing to take nitroglycerin or another nitrate, then using Viagra to engage in sexual activity shouldn’t pose a problem.

That said, there’s no way to be sure Viagra will be 100% safe for you. Some men are more sensitive to Viagra’s blood pressure-lowering effects. It may interact with other drugs in unexpected ways. And it’s never safe to use with nitroglycerin or any other nitrate, because this combination can lead to dangerous drops in blood pressure. If you’ve taken Viagra and start having chest pain or other symptoms of a heart attack, don’t be shy–tell the doctors who are treating you that you’ve taken the drug.