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Move over, Viagra

Kenneth Howe

THE LEGITIMISATION OF an industry that treats sexual dysfunction has launched the race for world sexual armament - for a female equivalent to Viagra as well as a contender to Viagra for men. The forefront of initial testing for a Hong Kong-owned company, NexMed, has taken place practically in view of the SAR's high rises: the beds of Guangdong province.

Just as the birth-control pill instigated a cultural shift and liberated young people to experiment with sex outside of marriage, Viagra-like medications for women hold promise of the next sexual revolution. About 43 per cent of women - one in four being non-menopausal - experience some kind of sexual dysfunction, according to a study published last year in the Journal Of The American Medical Association.

NexMed's topical cream, Femprox, is designed to treat female arousal disorder, or a physiological lack of lubrication and blood flow to the genitals in a sexual situation. Its active ingredient, prostaglandin, a naturally occurring substance in men's semen, is a vasodilator, dilating arteries and thereby increasing blood flow to genital tissues.

In the first phase of women's testing which concluded last December in the United States, of 31 volunteers aged 18 to 61 years old - all of whom never had pleasant sensations during intercourse - 25 experienced heightened sensation after a topical application of the cream, says Dr Y Joseph Mo, the president of NexMed.

The second phase of testing is scheduled to start in the US before the year's end and it is hoped Femprox will be commercially available there in 2003. But NexMed hopes to make Femprox available a year earlier in China, by 2002, with initial testing begining there early next year.

Taiwanese-born Mo chats in NexMed's Causeway Bay office, though he spends most of his time at the headquarters in New Jersey. The company is up against pharmaceutical empires - there's a crop of at least nine other bio-tech companies working on similar drugs intended to increase blood flow to the genitals. 'We've been keeping a low profile,' he says, lest, for instance, powerful multinationals start lobbying in China against their testing.

In the race to make anti-impotency drugs commercially available, the mainland has served as a shortcut for NexMed. The men's drug, Alprox TD (which also uses prostaglandin), was tested in Guangdong and later Beijing for two reasons: time and money. Industry averages show that in China drugs cost US$40 million (HK$311.6 million) to test and reach the market in four years compared with US$500 million and 11 years in the US, Mo says, largely because China's regulatory body is less stringent than the US Food and Drug Administration.

NexMed plans to go first to China's market with Alprox TD, its Viagra contender, by the end of the year and Hong Kong shortly thereafter. 'It is the first time a breakthrough product has ever been offered first to the Chinese market,' Mo says.

The advantages of Alprox TD as Mo sees them? Viagra takes about one hour to take effect, Alprox TD about 10 to 15 minutes. 'Then you're ready for action,' Mo says. Also, it's safe, he says. In testing of 400 men in Guangzhou and Beijing, the worst side effect, experienced by 10 per cent, was a mild burning sensation (some women experienced it as well).

Third, it's powerful, Mo says. In testing, Alprox TD's efficacy rate has proven to be on par with Viagra. In a sample of 160 Chinese men, aged 21 to 72 years old and categorised as mild to moderate cases, 75 per cent of them had improved erections over a four-week period, according to results announced in August at the Fifth Asian Congress on Urology in Beijing.

Despite the seeming benefits of testing the drugs in China, NexMed initially eschewed testing Femprox there for fear of upsetting the mainland's conservative socio-political environment, says Mo, citing a traditional Asian cultural belief that says women shouldn't have orgasms. 'The availability of this kind of medication may create a sexual revolution,' he says. 'We don't want to generate controversial publicity.'

As an example of Asian conservatism, at a urology conference in Singapore this spring, some of the 200 male and female attendees told Mo, 'This isn't a product for Singapore. We don't need it.' Despite such attitudes, Chinese women will likely take part in testing beginning early next year barring 'unforeseen social resistance', Mo says. But far from contemplating his role as an agitator of China's restrained social mores, he merely states, 'I think only as a scientist.'

Culpability, in fact, is largely absent among researchers, doctors and pharmaceutical concerns - partly due to the breakneck pace of research - yet the most significant implication of all their efforts must be: better loving through chemistry.

Already with Viagra, non-impotent men are murmuring at dinner parties, after the wine and over cigars and port, about the benefits of Viagra. But whether love drugs can enhance sex for fully functional people is an issue that 'is so politically incorrect to talk about in the US', says Dr James Yeager, vice-president of research and development for NexMed, who works out of Chicago. Even Pfizer, the maker of Viagra, has tiptoed around the topic.

Yeager, who has studied erectile dysfunction for 10 years, 'suspects it will be an enhancement to pleasure' for both men and women but is quick to point out that NexMed isn't even testing 'non-diseased' people. But even dysfunctional Chinese men, in the clinical trials, discovered they could perform for about half an hour longer than normal - about 45 minutes. Ultimately though, Mo says, 'it's not a sex drug, it's therapy for patients'.

Even so, NexMed, and other companies, hope to make their products available over-the-counter, without a prescription, making it available to all. NexMed hopes Alprox TD will be available over the counter on the mainland after its second year.

'Up to this point no one has taken us seriously,' Mo says. One and a half years ago NexMed was US$6 million in debt. The company was bailed out by a group of Hong Kong contacts, private investors who only agreed to share the company's story if they remained anonymous.

On October 6, NexMed secured a Nasdaq listing in the US and is considering seeking a listing on Hong Kong's Growth Enterprise Market, in which case it would be the GEM's first listed bio-tech. A stock that once traded for as little as 70 US cents per share is now trading at US$14. Cash-flush to the tune of US$43 million, 'We're now ready to go against the big boys,' Mo says.

Alprox TD will cost 120 yuan (about HK$110) and will be good for four uses, Mo says. One 50-milligram tablet of Viagra costs about 100 yuan. 'Next year,' he proclaims, 'we're going to become the Viagra of China.'

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