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The latest film by director Spike Lee is a musical about the discovery and success of sildenafil.

The filmmaker, best known for films like Do the Right Thing, Malcolm X and 4 Little Girls, has co-written a screenplay based on an article about the discovery and launch of the erectile dysfunction medication, better known by the brand name Viagra.

The musical will chart the discovery by drug company Pfizer of Viagra from its initial research, to finding out its effectiveness for ED to how it changed the world, based on an article by David Kushner called All Rise.

The story of sildenafil’s transformation from failed angina drug to a billion-dollar industry that has also enabled people to buy Cialis, Levitra and other major PDE5 inhibitors is fascinating, and as much about determination as it is medical research.

The Story Of Sildenafil

What often needs to be reiterated in an age where PDE5 inhibitors are not only widely used but also available as a generic medication is that when sildenafil was originally discovered and was being trialled chemical treatment for erectile dysfunction was in its infancy.

The Brindley lecture, the infamous 1983 Las Vegas lecture where Professor Brindley injected himself with an experimental erectile dysfunction medication (papaverine) and dropped his trousers in front an audience of urologists, was only six years previous.

Before that, practically everything had been tried, from vacuum pumps (still used in some cases for ED) to goat testicle grafts (which were never successfully used). At the time, impotence and erectile dysfunction were seen as psychological rather than clinical conditions.

The initial aim was to create a type of phosphodiesterase type 5 (PDE5) inhibitor and use it as a new form of heart medication. PDE5 is an enzyme found in the walls of blood vessels that are used to affect blood flow so inhibiting this can help control blood pressure and blood flow.

There were connections between PDE5 inhibitors and improved pulmonary and respiratory health as far back as 1886, where Henry Hyde Salter realised his asthma symptoms reduced after a strong cup of coffee, with caffeine being a very weak, non-selective PDE5 inhibitor.

That same principle guided the Pfizer scientists based in Sandwich, Kent, on an angina medication (a heart condition based on poor blood flow) using a PDE5 inhibitor.

Early clinical trials found that it was sometimes useful for angina and had uses for other heart conditions, but one thing that was noticed was that it induced erections in many of the patients.

Initially, this was seen as a side effect, but a pilot study showed that it was the other way around; sildenafil was not a heart medication that gave erections, but an erectile dysfunction medication that can help with chest pains.

The second part of the story of Pfizer is not about proving it is effective, but enabling people to have a conversation about a topic that in a conservative business was seen as a taboo, and in the medical world was not seen as treatable.

Eventually, the solution was not just to give a potential treatment but also to change the conversation, and this was the origin not just of Viagra but of the term erectile dysfunction.