There was a red letter day on March 27, 2011. It was the thirteenth birthday for the little blue pills. The FDA, in its wisdom, gave its approval and launched the first oral treatment for erectile dysfunction on to the market. It's perhaps hard to imagine how big the revolution was. Up to then, most men with the problem had hidden away. Their shame prevented them from talking to anyone about it. Yet, when the news of the product was released, it was like a dam bursting. Suddenly several million men were on the move. Queues formed to see doctors who were equally unprepared. No one had thought to train them how to talk about sexual problems with humiliated men. Everyone covered up their embarrassment by saying as little as possible as the prescription changed hands. Even pharmacists got into the conspiracy of silence. Once the prescription was handed over the counter, no one spoke. The pills were handed over in a plain paper bag. Dignity was maintained.

The situation is rather different now. The new generation of doctors has been specifically trained to relate to their patients. The reason for this has been detailed research evidence showing that men who present with erectile dysfunction under the age of forty are likely to have a stroke or heart attack within five years. The reason is that the artery in the penis is like the canary in the mine. It's the first obvious symptom of artherosclerosis which, unless treated, leads to heart disease. This means that all men who go to their doctors will be screened for symptoms of heart disease. Early preventative treatment will keep men alive for longer to enjoy their new sex lives.

Yet, in a way, this training has not been a complete success. There are two quite different reasons. First, men can now buy their pills online without ever having to see a doctor. This preserves their privacy and saves them money - even when you add in the cost of shipping, it's still cheaper to buy from an internet pharmacy. Second, the health insurance companies have begin to impose very specific expectations about the flow of patients through a doctor's surgery. Most doctors are now under pressure to spend only a few minutes with each patient. Carefully prepared scripts and examinations are no longer possible except when the consult is paid for privately. Ironically, after thirteen years we are back to the original situation with doctors not giving their full time to patients and men preferring to stay home. The only difference is the free availability of the drug online.

Pfizer has been celebrating the profitability of Viagra, conscious of the fact that the patent protection will soon end. That will release a flood of generic drugs on to the market. They are usually called Sildenafil and, like the drugs available online, they are a lot cheaper than the branded equivalent. It will be very interesting to see how Pfizer reacts in 2012 when the patents end. Sales in 2010 missed the $2 billion mark both because of the high price and the competition from the other branded drugs. Viagra is in for an interesting fourteenth birthday.