By Justin Gillis
Washington Post Staff Writer
Sunday, April 26, 1998; Page A01

Find a sympathetic doctor these days and head down to the corner drugstore with a few prescriptions in hand, and you can walk out with a sack of goodies that promise to make life better.

There's Propecia, a $50-a-month treatment to make a balding man's hair grow back. There's a prescription cream called Retin-A to make wrinkles fade. There's Prozac for positive thinking and a new drug that can make folks thinner.

And now, of course, there is Viagra, an impotence treatment that some urologists believe will make sex better even for men who aren't impotent. For that matter, it may make sex better for women who take it.

This is the new frontier of drug development, quality-of-life pharmacology. The products on the market now are merely the first wave. In the laboratories of the nation's drug and biotechnology companies, a dazzling array of new treatments are under development.

Taking advantage of growing knowledge of the body's elementary processes, scientists at these companies think they'll be able to restore joints damaged by arthritis, lower the body's "set point" to banish flab, grow new blood vessels to replace ones that clog up, stop age-related degeneration of the eyes and bones. In short, they hope to keep people looking and feeling vigorous well into the decades that used to be regarded as old age.

Among scientists there isn't much question that a lot of this will happen -- the only real question is how soon.

"Where all this technology is taking us is into a series of qualitative improvements in people's lives," said William Haseltine, head of Human Genomes Sciences Inc. of Rockville, a company in the vanguard of the new pharmacology. "We'll be using our knowledge to help the body rebuild itself."

Yet this push for quality-of-life drugs raises vexing new questions for the nation's health-care system. Foremost is the issue of cost. Drug and biotech companies are investing billions to develop the new treatments, in part because they realize that people will pay extraordinary prices to get them.

The nation's insurers and large private employers already are deeply worried about the potential cost of these drugs. While overall health-care inflation has been brought under control by the advent of managed care, some big insurance plans have been reporting double-digit increases in the last couple of years in prescription costs.

Insurers fear that a few more expensive drugs like Viagra could help to reignite health-care inflation.

Certainly there's no question that the public wants the drugs. As the nation's pharmacopeia expands over the next decade, it will find a prime market in the baby-boom generation, the 76 million Americans born from 1946 to 1964. The youngest of the baby boomers are turning 34 this year and the oldest are turning 52. These are precisely the years when people first begin to rue the indignities of advancing age.

Many of the baby boomers were teenagers and young adults in the 1960s and so are often familiar with the idea that life can be improved with drugs. They are, moreover, a politically potent and demanding segment of the population, not likely to roll over just because insurance companies don't want to pay for things. To this market, drug and biotech companies hope to introduce a whole slew of new compounds over the next few years that help to slow down the ravages of age.

There's nothing new about the idea that pharmaceuticals can improve one's quality of life. Not dying of bacterial infections because antibiotics are available is certainly a quality-of-life improvement. What is new, perhaps, is the focus on personal happiness as a prime or even the sole criterion by which to measure the worth of a drug.

"There was a time when drugs to make you thin or drugs to make your hair grow again were kind of looked down upon," said Mark Edwards, a biotechnology analyst in San Francisco. "Now, these things are starting to be looked at as real medicine."

Many of the new drugs, such as those under development to help people lose weight, will be possible because science is gaining a deep understanding of the way the body works at the molecular level. Researchers are racing to unravel the body's genetic code, gaining clues to the underlying causes of conditions such as obesity and to the degenerative changes that accompany aging. Once the root causes are understood, highly specific drugs can be designed to target each problem.

"This really is the golden age of pharmaceutical research," said Andy McCormick, a spokesman for Pfizer Inc., the company that developed Viagra. "We are learning a tremendous amount rapidly, a lot of it based on the genetic revolution. We're taking the insights that we're gaining and applying them to quality-of-life medicines. And Viagra is a good example."

It also is a good example of how costly the new drugs will be to develop and buy. Pfizer says it spent $500 million developing Viagra. Drug companies estimate they are spending about $20 billion a year developing new treatments, a number that has been rising faster than inflation.

Given the up-front development costs, Pfizer says it's justified in charging about $7 at wholesale for one 50 milligram tablet of Viagra, a price that makes it 14 times more expensive than its equivalent weight in gold. Viagra costs $10 a pill at retail. Yet that hasn't stopped the many thousands of men who are demanding the drug.

In its second week on the market, ending April 10, doctors wrote 36,263 prescriptions for Viagra, according to figures compiled by IMS America Ltd., a company in Plymouth Meeting, Pa. that tracks prescriptions.

That was before a frenzy over the drug gripped the nation in the past couple of weeks. No detailed figures for those weeks are available yet, but some estimates said doctors were writing as many as 40,000 Viagra prescriptions a day. If the demand holds up, Viagra may well become the best-selling drug in history.

Some insurance companies already are balking. Many of the carriers that insure federal employees, for instance, have specific provisions in their contracts that allow them to exclude treatments for sexual dysfunction.

The theory, going back decades, is that sex is not necessary to earn a living or get along in daily life, and treatment of sexual dysfunction is therefore not "medically necessary." Treating impotence is, after all, a question of personal happiness, not of survival.

Late last week some federal employees reported that their companies already were denying Viagra claims, even for men who can prove clinical impotence. A few health-maintenance organizations, including several on the West Coast, have announced that they will not cover it or will require strict proof of clinical impotence before they will.

In the end, the nation will have to decide case-by-case which of the new treatments to pay for through health insurance. It seems clear that drugs to regrow hair or banish wrinkles will not make the cut -- if people want them, they are likely to have to fork over their own money.

But what about drugs to banish fat? Many people will want to take them largely for cosmetic reasons, but if the drugs truly work without serious side effects, those same people are likely to see health gains, too -- starting with fewer cases of heart disease and diabetes, which are major complications of obesity. This could not only make people healthier, but save money in the long run through lesser use of hospital beds and other expensive treatments.

Will insurance companies require that people be overweight by a certain fixed percentage before they'll pay for the drugs? Will they feel it necessary to set limits on how many pills of Viagra an impotent man can buy with his insurance card -- deciding, in effect, how many episodes of sex a week are reasonable for a man of a certain age?

And if there are no limits, are Americans prepared to see the cost of health care start rising again, undermining economic growth and hurting people who aren't wealthy?

"We've had a kind of honeymoon in the last few years on health-care costs," said Helen Darling, a benefits analyst with Watson Wyatt Worldwide, a consulting company. "These new treatments, repairing damage done over a lifetime, will force a new public debate about what costs should be borne by everyone through socialized dollars. I believe the big crunch is still ahead of us."