Before LillyDirect, There was Viagra Home Delivery

Ralph Steadman

On the Road. Again.

“What is that feeling when you're driving away from people and they recede on the plain till you see their specks dispersing? It's the too-huge world vaulting us, and it's goodbye. But we lean forward to the next crazy venture beneath the skies.”

― Jack Kerouac, On the Road

Everyone is disoriented with the fuzziness of the moment. There are no rules to manage the metabolic signatures being left on our psyches by the Silicon Valley visionaries, no maps to navigate the science-fiction territory in front of us. And so The Roadtrip will be uncertain, unpredictable and its destination ultimately unknowable in advance.

We are confident in nothing, other than “the 2030s are likely going to be wildly different from any time that has come before” because, well, Sam Altman says so. In a blog post titled “The Gentle Singularity” published in June, Altman argued “we are past the event horizon; the takeoff has started.”

We are leaving. We just don’t know to where.

We have reached the place where an inversion of the expected order has happened, a fabulous warp where you take the journey first and then you make your departure. And for the long stretches over the raw land, we can listen to the matter-of-fact proclamations and pontifications of the Big Tech philosophers role-playing, sounding like kids playing a strategy game.

Not long before the launch of GPT-5, Altman appeared on the comedian Theo Von’s popular podcast. The discussion veered into the fantasy world that Altman, and many of his peers, tends to inhabit.

At one point, the two had the following exchange:

Altman: I do guess that a lot of the world gets covered in data centers over time.

Von: Do you really?

Altman: But I don’t know, because maybe we put them in space. Like, maybe we build a big Dyson sphere around the solar system and say, “Hey, it actually makes no sense to put those on Earth.”

Von: Yeah.

Altman: I wish I had, like, more concrete answers for you, but, like we’re stumbling through this.

What the fuck are you talking about Sam? What exactly is the contemporary traveller, listening in their car on the way across the Great American landscape, to make of conversations like this? Sure, there’s probably a cohort that finds covering the Earth or atmosphere in data centers very exciting. But what about those of us who don’t? Altman and lesser personalities in the AI space often talk like this way, making extreme, disorienting promises and sales pitches born from the technical potential of technology.

But this isn’t a business plan; it’s an idle daydream.

As we race past the “event horizon”, out there somewhere on the edge of the desert, probably around Barstow, that terrible roar we hear all around us is what Kyla Scanlon in her Substack calls The End of Predictable Progress. Broadly, we're not just watching an economic transformation, the Total System Collapse of the Standard Model of Thought. We're witnessing the birth of entirely new ways of understanding who we are and how we fit into the world.

“For better or worse, the rise of figures like Andrew Tate alongside the growth of democratic socialist movements are competing narratives about how to make sense of a world where traditional economic stories no longer work,” she says.

We are facing multiple shifting paradigms, she says, a total change in context, a double disruption -- (1) technological creative destruction in the form of new technologies combined with (2) political creative destruction in the form of the Trump administration. It’s a deep structural shift reshaping not just generational identity, but generational opportunity.

The Great Relearning in Pharma

Before LillyDirect, before Trump's Letter to the leaders of 17 major pharmaceutical companies, calling on them to launch direct-to-consumer and/or direct to business distribution platforms, before BlinkRx, a company that has Donald Trump Jr. on its board touted in a press release last week “a new initiative” to help pharmaceutical companies launch direct sales platforms, before all the peril and potential from Big System Change and institutional instability unfolding globally, there was Viagra Home Delivery.

Circa 2013:

Pfizer launches online home delivery service for Viagra

Pfizer has partnered with a leading US pharmacy chain on a new home delivery initiative for its erectile dysfunction (ED) brand Viagra (sildenafil).

The venture is based around an e-commerce website that will allow patients in the US with a valid prescription to buy Viagra online or refill an existing prescription, estimate their insurance co-payments and check on the status of their order.

The new website can be accessed via Pfizer’s Viagra.com site. All of its functionality, including prescription authentication, will be handled by CVS/pharmacy.”

Viagra Home Delivery never really passed through the ‘protocommercial phase’, at least not at the scale of delivering the kind of big business value that matters to $64 billion-a-year Pfizer. The motivation behind it made sense, though the roadmap itself ultimately became a trail of intention gone haywire.

At the time, Viagra was still a big brand, but generic competition was looming, as it always does in the drug market, the same storyline of “crisis” and “collapse” repeating itself as an infinite loop in time, regardless the drug brand, each strategy reaching a point which so many resign themselves to cutting their losses and their hopes. (To dig deeper, see Why the Pharmaceutical Industry Needs to Think Like Quentin Tarantino.) The Viagra Home Delivery model was meant to (a) protect brand trust, (b) capture revenue directly instead of through middlemen, and (c) address the stigma of buying ED meds in person.

Generic sildenafil entered the U.S. market in 2017.

Men could get the same medication at a fraction of the cost from local pharmacies, discount programs, or, at the time, newer telehealth startups, who built much more consumer-friendly subscription models. Pfizer’s experiment was run more like a traditional pharma “pilot” than a true consumer business. This is also one reason why LillyDirect has so far only served 4400 consumers since it was launched last year, or about 0.00293 percent of a total addressable market in the United States of 150,000,000. (Note to pharma: if you build it, assume they won’t come.). (Note to pharma: if you build it, assume they won’t come.)

Pfizer shut down its direct-to-consumer Viagra delivery once generics eroded market share. Today, Viagra as a brand-name drug is still available, but most patients get generic sildenafil through retail pharmacies, mail order, or telehealth platforms — not from Pfizer.

Grammar acts like a film director, telling the brain what to model and when. Words generate neural movies in the minds of their readers. When the same words are said the same way, you get the same stories, a huge dump of clichéd metaphors that have become worn-out by overuse. An entire industry is slouching towards the status quo,not marching to big market innovation, because its language is less and less vivid, less vibrant, less likely to provoke or inspire.

To wit this from IQVIA last week (The Rules of Loss of Exclusivity are Being Rewritten):

As the life sciences industry braces for the most formidable wave of Loss of Exclusivity (LOE) in more than a decade, dubbed Patent Cliff 2.0, pharma executives are under pressure to do more than just brace for impact. Patent losses at estimated net manufacturer prices are set to exceed $90B between 2025-2029, more than in either of the last two 5-year periods. With a mix of both small and large molecules that will see generic and biosimilar competition, these products are in many of life sciences’ largest therapeutic areas. Market fluctuations will be widely felt.

The next decade in life sciences will be a Brave New World. The product lifecycle is facing economic compression from launch to LOE due to the confluence of market dynamics, price erosion, and public policy. Addressing the new lifecycle rules for the next 10 years requires a broad rethink of the last two decades. When it comes to LOE, extending the area under the economic lifecycle curve takes on added importance because of the compression that is occurring earlier and elsewhere in a portfolio.

It is enticing to believe that a market is at the cusp of yet another revolution, making all before obsolete, but that process through history is shown to be an oversold siren’s song more than not. The obstacle blocking that generational jumping is the narrative layer, or more precisely an entire economic system stuck servicing narrative debt, the legacy words having veto power over the new.

The more familiar the expression, the less it activates the motor system.

Story is what brain does. It is a ‘story processor’ not a ‘logic processor’, writes Jonathan Haidt, social psychologist and professor of Ethical Leadership at New York University's Stern School of Business.

New Narrative Matters

Things naturally become worse when our fact-checking senses become damaged, which is what scares me the most from the bullshit coming out of the AI bubble machine, the soaring spiritual exuberance calling on us to outsource big chunks of our minds. So how do we change a mindset as opposed to doubling down on a thinking of “all is new” that has failed us so clearly?

Tom Wolfe, in The Great Relearning:

“Start from zero” was the slogan of the Bauhaus School.

The story of how the Bauhaus, a tiny artists’ movement in Germany in the 1920s, swept aside the architectural styles of the past and created the glass-box face of the modern American city is a familiar one.

But I should mention the soaring spiritual exuberance with which the movement began, the passionate conviction of the Bauhaus’s leader, Walter Gropius, that by starting from zero in architecture and design man could free himself from the dead hand of the past.

By the late 1970s, however, architects themselves were beginning to complain of the dead hand of the Bauhaus: the flat roofs, which leaked from rain and collapsed from snow, the tiny bare beige office cubicles, which made workers feel like component parts, the glass walls, which let in too much heat, too much cold, too much glare, and no air at all. The relearning is now underway in earnest.

The architects are busy rummaging about in what the artist Richard Merkin calls the Big Closet. Inside the Big Closet, in promiscuous heaps, are the abandoned styles of the past.

Which is why AI is really a mass-delusion event, why IQVIA’s call for a “broad rethink” falls flat, and why the “end-to-end digital healthcare experience” promised by LillyDirect has only 4400 users (out of a total addressable market of 150 million): These stories don’t free us from the dead hand of the past.

The Problem everyone seems to be struggling with today is finding and then communicating strategic fit to the rapid and intentional disassembly of the old order.

Jack Kerouac’s 1957 novel On the Road is a seminal work of the freewheeling Beatnik movement, the road tripping travelogue spoke to a watershed moment in youth culture when postwar disillusionment, the questioning of traditional gender roles, and the exploration of sexuality were beginning to break surface. The wholesale rejection of hearth and home for the uncertain road was a thrilling prospect at the time of On the Road’s publication.

What today looks like a conservative shift worldwide might actually be something more fundamental: a generation's attempt to navigate a world where institutions promise stability they can't deliver, where algorithms offer opportunity without security, and where the very nature of work and worth is being redefined.

And it’s not just politics — it’s the very nature of self being called into question. (To dig deeper: see Who Does Pharma Choose to Be?)

Simpler to start from zero, with different stories, a new grammar of strategy.

/ jgs

John G. Singer is Executive Director of Blue Spoon, the global leader in positioning strategy at a system level. Blue Spoon specializes in constructing new industry narratives.