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Dan Thompson participated in a study of the drug Propecia, which treats treat hair loss in men. The drug costs about $1 per day and must be taken for the rest of the patient's life.Todd Bennett/Staff

Gone today . . . hair tomorrow

Demand for baldness cure, other drugs concerns physicians

Web posted May 7, 1998

By Tom Corwin
Staff Writer

Dan Thompson almost sounds like a commercial for Propecia.

``After about three months on the drug, I would be at work and I would have co-workers come up and say, `Hey Dan, your hair is really growing,'^'' said Mr. Thompson, 43. ``I started looking in the mirror and, sure enough, I was growing hair. It was a noticeable difference.''

The giddy experiences of men like Mr. Thompson, who were formerly resigned to male-pattern baldness, have fueled demand for Propecia, the first prescription pill shown to grow hair. The pill's manufacturer, Merck & Co., began an advertising campaign this month to spread the word about the pill Mr. Thompson first got during a controlled study at Medical College of Georgia. Finasteride, Propecia's generic name, was originally approved as a treatment for enlarged prostate, but doctors began noticing the side effects of hair growth.

Both Propecia and another hot drug for male malaise, the impotence pill Viagra, are symbols of a new age of pharmaceuticals -- breakthrough drugs marketed directly to a public eager for a magic bullet for age-old problems like thinning hair, bulging waistlines or sexual dysfunction. But with these new wonder drugs, which can rack up millions of prescriptions in a matter of weeks, also come potential problems, said Ronald Lewis, chief of urology at MCG, who has studied both drugs.

In Propecia's case, the cost may far outweigh the benefit. Several men have already approached Paul Fischer at Primary Care Associates in Augusta and clamored to get on the baldness pill. But he doesn't think that appeal will last long.

The impotence pill Viagra is shown in this handout photo.AP Photo/Pfizer

``You've got to take it for the rest of your life at $1 a pill a day,'' Dr. Fischer said. And studies show only one-third of the men got any significant hair growth from it, he said. ``It's just an expensive drug for a modest return.''

Merck insists Propecia will prove its worth, particularly in light of other baldness options.

``We think the value Propecia has is an excellent value compared to other methods men have tried to deal with this problem,'' said Merck spokesman John Bloomfield.

But Dr. Fischer said he would recommend hair transplants, which while more expensive, also last much longer and provide proven results.

In fact, once the drug is discontinued, the hair begins to disappear, said Mr. Thompson, who has already lost much of the hair he gained from a year on finasteride. Still, he is hoping to get into a second finasteride study at MCG, this one looking at the smaller dosage of finasteride used to treat hair loss and whether it will still affect prostate-specific antigen levels, a key indicator of whether a man is developing prostate cancer.

One of the concerns about Propecia is that it cuts prostate-specific antigen levels in half. Test results could appear artificially low when there might actually be cancer, said Dr. Lewis.

``You may be led into thinking it's normal'' when it's not, Dr. Lewis said.

But that is covered in the prescribing information for physicians, who are told to double test results, said Mr. Bloomfield, the Merck spokesman.

And while there were some slight impotence side effects, the drug racked up $13 million in sales in the first three months, even before the marketing campaign began, Mr. Bloomfield said.

Viagra didn't even need a marketing campaign -- the announcement that it had been approved by the Food and Drug Administration was widely reported and closely read. Sales were so brisk that its maker, Pfizer, doubled its stock price. Both methods of public notification -- news release and marketing -- signal a new era for drugs, Dr. Lewis said.

``The idea of directly marketing it to the public is a new concept,'' he said. And a disturbing one -- many new drugs have Internet sites that can sign up patients with doctors in their area who are prescribing the drug, Dr. Lewis said.

``They're marketing it to the public almost before they're informing the physicians,'' Dr. Lewis said, in effect ``bypassing the physician.'' Merck said it intentionally waited from December -- when Propecia was approved -- until April to give physicians time to become familiar with the drug, Mr. Bloomfield said.

And while both drugs have received FDA approval as safe and effective, there is still the question of what happens to patients who take the drugs for several years, Dr. Lewis said. Viagra, for instance, works to overcome impotence by stopping an enzyme called phosphodiesterase 5, which breaks down a chemical that acts on smooth muscle in the penis to allow the erection. But a similar phosphodiesterase enzyme is found in the heart and in the eyes, and early studies have found that vision problems were among the rare side effects of Viagra, Dr. Lewis said. How those similar enzymes would be affected by years of use is unknown, Dr. Lewis said.

The company can prove it works and that's all that many patients want to hear as they rush into the office, Dr. Lewis said.

``Somehow, we need to slow that process down,'' he said.

And while it may indeed be a near miracle for a man who has been losing hair since he was 21 to suddenly sprout new growth, even Mr. Thompson feels the need to put Propecia in perspective.

``I have two children,'' he said. ``That $50 a month or whatever it is can go to a lot more important places than on top of my head.''